Multidisciplinary Training Research Articles

Research on Talent Training Mode of Interdisciplinary Integration in Colleges and Universities

Interdisciplinary and integrated talent training is not only the urgent need of economic, scientific, technological and social development, but also one of the inevitable trends of higher education and teaching reform. Firstly, this paper analyzes and summarizes three types of multidisciplinary talent training modes in American universities, namely, project-based interdisciplinary talent training mode, professional education based interdisciplinary talent training mode and curriculum based interdisciplinary talent training mode. Then, it compares and analyzes four modes of interdisciplinary talent training in Colleges and universities in China, namely interdisciplinary curriculum mode, interdisciplinary project mode, interdisciplinary specialty mode and interdisciplinary degree mode. Finally, it puts forward the design idea of curriculum system of interdisciplinary and integrated talent training mode in China.

Building telehealth teams of the future through Interprofessional curriculum development: a five-year mixed methodology study

ABSTRACT Building the next generation of telehealth enabled professionals requires a mixture of team-based, interprofessional practice with novel technologies that connect providers and patients. Effective telehealth education is critical for the development of multidisciplinary training curricula to ensure workforce preparedness. In this study, we evaluated the impact of a formal telehealth education curriculum for interprofessional students through an online elective. Over 12 semesters, 170 students self-selected to enroll in the 3-credit hour interprofessional elective and took part in structured didactic, experiential and interprofessional learning opportunities. Mixed-method assessments show significant knowledge and confidence gains with students reflecting on their roles as future healthcare providers. The results from five years’ worth of course data shows not only an opportunity to advance the individual knowledge of trainees, but a larger movement to facilitate changes in practice toward population health goals. Recent global health events have further highlighted the need for a rapid response to public health emergencies by highly trained provider teams who are able to utilize technology as the cornerstone for the continuity of care.

The Role of Race in Social and Emotional Learning (SEL) Training for Preservice School Social Workers and Teachers

Abstract Race is often ignored as a core component of social and emotional competency (SEC) and social and emotional learning (SEL). This study explored preservice school social worker and elementary teacher interns’ participation in a collaborative, multidisciplinary SEL training curriculum that integrates race. Nine preservice trainees (majority White women) participated in the collaborative training. Qualitative methodology was utilized to examine and access the training. Content analysis revealed three themes from a study of the interns’ participation in the training: function of color blindness, “I haven’t noticed,” and silencing of emotions. While interns acknowledged the importance of race, they were unclear on how students’ racial identities were a key component of students’ SEC. They also struggled to find ways to incorporate race in their implementation of SEL. Findings are discussed regarding the role of race and preservice training in SEL.

52 AUDIT CYCLE EXAMINING QUALITY IMPROVEMENT POST EMERGENCY DEPARTMENT MULTI-DISCIPLINARY SIMULATION BASED MEDICAL EDUCATION TRAINING ON HIP FRACTURE CARE

Abstract Background The care of patients with hip fractures is a surrogate marker of trauma care. Irish hip Fracture Standard 1 involves patients with a hip fracture being admitted to an orthopaedic ward bed within 4 hours of attending the ED. We wanted to audit our current practice and introduce a quality improvement project to improve the timeliness and efficiency of care of our hip fracture patients compared with the gold standard IHFS 1. We introduced a 90 minute multidisciplinary simulation training programme on the hip fracture pathway to our ED in February 2021. All key stakeholders were represented; from Emergency Medicine, Orthopaedics, Nursing (EM and Orthopaedic), Radiology, Radiography, Porters (32 people overall). Because of COVID-19, the training was available in person and online via Zoom. Methods We performed a retrospective audit of patients presenting to TUH ED with a proximal third of femur fracture between 4th February and 31st March inclusive in 2020 and 2021, pre and post introduction of multidisciplinary simulation based medical education on the hip fracture pathway. Data was collected from the electronic record database (Symphony). We recorded the following data; Results 2020 n = 31. Average time to ward—8 hrs 29 mins. 26% patients reached ward <4 hours. (8/31). 2021 n = 25. Average time to ward—5 hrs 58 mins (32% reduction vs 2020). 72% patients reached ward <4 hours. (18/25) (46% increase vs 2020). Conclusion Simulation based medical education is a successful intervention to improve compliance with our hip fracture pathway, time from presentation to transfer to an orthopaedic ward bed and achieve IHFS 1.

Последипломная подготовка специалистов как важное условие и составляющая создания и развития системы паллиативной и хосписной помощи

Актуальность. Согласно международным стандартам и подходами, адекватное кадровое обеспечение является обязательным условием и составляющей создания и успешного развития системы паллиативной и хосписной помощи (ПХП) в любой стране. Одной из основных задач современной профессиональной подготовки медицинских работников (М/Р), которые привлекаются к оказанию ПХП населению, является формирование у них осознания пациент-семья-ориентированной парадигмы, навыков мультидисциплинарной (МД)/командной, межведомственной и межсекторальной координации и сотрудничества. Также важно обеспечить тщательный отбор и соответствующую мотивацию кадров. Поскольку в основе современной системы ПХП лежит МД, межведомственный и межсекторальный подход к оказанию ПХП после соответствующей профессиональной подготовки могут привлекаться врачи любой специальности, младшие медицинские специалисты, а также психологи, социальные работники, юристы и священнослужители, волонтеры, представители местных общин и частных структур, а также сами паллиативные пациенты (ПП) и члены их семей или опекуны. Цель: научное обоснование профессиональной последипломной подготовки специалистов), которые привлекаются к оказанию ПХП населению. Материалы и методы. Нормативно-правовые документы Украины и авторитетных международных профессиональных организаций; отечественные и зарубежные литературные источники с использованием поисковых систем JAMA, Scholar и PubMed; данные официальной статистики; результаты социологического исследования; методы исследования: системного подхода и системного анализа, библиосемантичний, социологический (анкетный опрос) и общепринятые медико-статистические методы. Результаты. Анализ национальных и международных нормативно-правовых документов свидетельствует о важном медико-социальном значении создания и развития системы ПХП населению. Показана роль профессиональной подготовки специалистов по вопросам ПХП. Результаты социологического исследования позволили определить: расчетную потребность населения в ПХП в Украине; состояние службы ПХП и недостаточный уровень знаний и настоятельную потребность М/Р в специальных знаниях по вопросам ПХП. Выводы. Мультидисциплинарная профессиональная подготовка специалистов имеет большое значение для создания системы и повышения доступности, качества и эффективности ПХП. Это позволит М/Р вместе с психологами, социальными работниками, волонтерами, священнослужителями обеспечить комплексную ПХП ПП и членам их семей, включая медицинскую, психологическую, социальную и духовную/ религиозную составляющую.

Perspectives of the Biomedical Engineering Program at UASLP after ten years - analysis and criticism.

The Biomedical Engineering (BME) bachelor pro-gram of the Faculty of Sciences in Universidad Autónoma de San Luis Potosí (UASLP) was created in June of 2010, with the aim of training professionals with an integral perspective in the engineering field by considering a multidisciplinary approach to develop and apply technology in the areas of medicine and biology. After 10 years, our BME program has achieved national recognition. Despite of being an emerging program, this achievement has been obtained by the consolidation of our academic staff, the outstanding participation of our students in national and international academic events, and the historical graduation results. In our comprehensive evaluation, we report an overall terminal efficiency (completion rate) of 67% and a graduation rate of 47.2%, where these values are above the average for an engineering program in our institution. Additionally, the BME program provides students with solid skills and background to carry out research activities, which has resulted in a considerable number of alumni pursuing graduate studies or have already completed one. Our results show that 90% of our former students are working after graduation, but only 44% work in the field of biomedical engineering, since the regional labor market starts to saturate given the fact that, at present, students from six generations have completed our BME bachelor program. In this way, few graduates visualize the wide spectrum of job options where a biomedical engineer can impact, by their distinctive comprehensive and multidisciplinary training. Therefore, it is necessary to propose new curricular design strategies to provide our students with an academic training that allows them to enter a globalized world, where there is an even greater spectrum of engineering possibilities related to the fields of medicine and biology, in line with current trends.

Transforming training into practice with the conflict management framework: a mixed methods study

ObjectiveTo implement and evaluate the use of the conflict management framework (CMF) in four tertiary UK paediatric services.DesignMixed methods multisite evaluation including prospective pre and post intervention collection of conflict...

Multidisciplinary Team Simulation Training for Successful Outcomes in Robotic Cardiac Surgery

Multidisciplinary Team Simulation Training for Successful Outcomes in Robotic Cardiac Surgery

Generic Crew Resource Management training to improve non-technical skills in acute care - Phase 2: A pre-post multicentric intervention study

BackgroundCrew Resource Management (CRM) training aims to improve non-technical skills to reduce preventable errors in healthcare. This study evaluates a generic CRM training program for acute care settings by assessing its’ effect on the four levels of Kirkpatrick. MethodsThe intervention entails a theoretical part and a simulation-based multidisciplinary team training including debriefing. Pre-post measurements were taken using questionnaires, observations and interviews. 231 Belgian physicians, midwives and nurses participated. ResultsOn level 1, respondents provided high scores and perceived the training as important. On level 2, a shift in knowledge, skills and awareness was found for 9/23 items. Observations showed safer teamwork on level 3 for all specialty areas. On level 4, a significant improvement was measured only for perceptions of management. Hierarchy and lack of a safety culture hinder the application of CRM in practice. ConclusionsA generic CRM-training invokes a positive reaction, changes attitude, knowledge, non-technical skills, and behavior. A one-time CRM-training is insufficient to change safety culture. The possibility of a generic training for acute specialty areas was confirmed.

TRACHEOSTOMY TRAINING AND TROUBLESHOOTING: A PANDEMIC EDUCATIONAL EFFORT

TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: The unprecedented COVID 19 pandemic has contributed to an increase in patients with respiratory failure many of which are requiring tracheostomy. As a result, the need for a working knowledge of tracheostomy care by many levels of care providers has soared. There are short and long term complications associated with tracheostomies. Multi-disciplinary team training for tracheostomy care may improve the care of these patients. METHODS: Medicine residents were given a pre-survey questionnaire to test their baseline knowledge on tracheostomies, understanding of available resources and comfort levels with dealing with day to day care and emergencies. Afterwards, a pre-test was given on knowledge about tracheostomies and daily/emergency management. Subsequently, they were given an educational presentation on tracheostomy selection, special COVID considerations, daily care and emergency troubleshooting. After completion of the education portion, residents underwent simulation lab training, comprising 4 stations: basic care;bleeding tracheostomy;accidental decannulation and tracheostomy obstruction. Residents were then re-tested to assess improvement in knowledge with plans to re-test in 6 months to monitor retention. RESULTS: Pre/Post survey results showed improvement in questions related to which service to call if there is a tracheostomy issue (69.9% to 92.3%), how to find tracheostomy specifics in the electronic medical record (13% to 61.5%), usefulness of a tracheostomy chart above the head of the bed (95.6% to 100%) and if tracheostomy emergency kits in each room were useful (91% to 100%). Pre/Post testing on the didactic and hands-on curriculum were administered. The pre-test results, no one passed as scores ranged 34-68 % out of a possible score of 100%. Post-test, everyone improved their scores with 75 % of learners passing the post test exam scoring 85-100%. Average test scores prior to lecture and simulation lab was 44%, compared to post test average of 83%. CONCLUSIONS: Residents increased their knowledge and awareness about tracheostomies as seen through improvements in all categories within testing. Residents favored specific educational scenarios about tracheostomy emergencies to delineate team training, roles and algorithms for care and in person training over online modules. This curriculum on tracheostomy troubleshooting and care can be operationalized for a wide array of team based multi-disciplinary providers throughout the spectrum of care. CLINICAL IMPLICATIONS: Standardized curriculum with clear objectives coupled with hands-on team training along with pre and post knowledge assessments can be readily implemented during a global pandemic. Further follow up assessments will be needed to determine if long term knowledge retention translates to sustained bedside benefit. DISCLOSURES: No relevant relationships by Alissa Ali, source=Web Response No relevant relationships by Doreen Kane, source=Web Response No relevant relationships by Louise Kane, source=Web Response Consultant relationship with Veracyte Please note: 2019-2021 Added 06/23/2021 by Carla Lamb, source=Web Response, value=Honoraria No relevant relationships by Tania Mangahas, source=Web Response No relevant relationships by Ekaterina Yavarovich, source=Web Response

Perceptions of barriers to patient financial hardship screening differ by provider role within gynecologic oncology outpatient care.

317 Background: Although approximately half of patients with gynecologic malignancy experience financial hardship (FH) during treatment, best practices to identify and assist patients with FH are lacking. To develop such practices, we assessed oncology provider and staff perspectives about FH screening and provision of assistance. Methods: An anonymous survey was conducted electronically within the Gynecologic Oncology outpatient office at a Comprehensive Cancer Center. Potential barriers to patient FH screening and follow-up were assessed within 2 domains: 1) logistic barriers to incorporating FH screening and follow-up into outpatient workflow and 2) perceived patient barriers to FH screening. Responses were elicited on a 5-point Likert scale from ‘very’ to ‘not at all’ significant and dichotomized into significant and not significant barriers. Results: Of 43 providers approached, 37 responded (86% response rate) of which 14 were physicians (MD)/nurse practitioners (NP) and 23 were other staff members (i.e., clinical and research nurses, social workers, pharmacists, care coordinators, lay navigators, and financial counselors). Altogether, 38% worked in their current position for >5 years (n=14), 11% for 3-5 years (n=4), and 51% for <3 years (n=19). For logistic barriers to implementing FH screening and follow-up, the most frequently reported significant barriers included lack of personnel training (69%) and lack of available staff (62%), training regarding follow-up (72%), and case tracking infrastructure (67%). The most frequent significant perceived patient barriers were lack of knowledge of whom to contact (72%), concerns about impact on treatment if FH needs were identified (72%), and lack of patient readiness to discuss financial needs (62%.) Compared to MD/NP, staff members more often indicated the following as significant barriers: difficulty incorporating FH screening into initial visit workflow (31 % vs. 57%, p=0.03), overstretched personnel (29% vs 73%, p=0.005), and patient concerns about influence on treatment (62% vs 86%, p=0.01). Conclusions: Care team members identified barriers to patient FH screening across logistic and patient-centered domains, although MD/NP less so than other staff possibly reflecting different exposures to patient financial needs during clinical encounters or burden of workflow. Implementation of universal FH screening, dedicated personnel, convenient tracking mechanisms, and multi-disciplinary provider and staff training may improve recognition of patient FH and facilitate its integration into oncology care plans.

Improving oral oncolytic education in a safety-net outpatient hematology-oncology practice.

266 Background: Oral oncolytics (OO) offer convenient administration and reduce the burden of cancer treatment, while creating particular challenges regarding safety monitoring and adherence. A baseline review of oral oncolytic education (OOE) at our safety-net institution identified that none of the patients who started OO therapy from September to December 2019 had complete documentation of OOE and a care plan. This results in potential increased risk of toxicity, non-adherence to therapy, and poor adherence to follow-up schedule for lab monitoring, dose adjustment, and toxicity assessment. Therefore, we sought to increase the percentage of completed components of an OOE and care plan that are documented in the EHR prior to new oral oncolytic initiation to 60% over a 6-month period. Methods: A multidisciplinary Quality Training Program team consisting of 2 physicians, an oncology pharmacist, and an oncology RN specialist was created. With stakeholder engagement, we identified barriers to quality OOE and documentation, including: unfamiliarity of staff with ASCO-ONS standards, adoption of a new EMR, lack of standardized structure and documentation for OOE, and limited number of staff. PDSA cycle 1 defined RN role as staff in charge of oral oncolytic prior-auth, coordination, and education process, reinforced communication of providers with RNs, and defined the components of oral oncolytic education and care plan that meets QOPI & ASCO-ONS standards. PDSA cycle 2 implemented a new simplified workflow which included (1) EHR worksheet to document oral oncolytic education, (2) in-person RN teaching, (3) printed education materials, pill box, and thermometer, and (4) 1-week follow up calls. Results: Our baseline data revealed that only 55% of patients had any documentation of OOE. Content of documented OOE varied significantly with only a mean of 37% ASCO-ONS safety standards being documented. During PDSA cycle 1 documentation improved to a mean 54% standards, and with PDSA cycle 2 82% standards of an OOE documented. Overall documentation of OOE, increased to 83% by PDSA cycle 2. Symptom check 1-week follow-up calls increased from 22% at baseline to 78% after PDSA cycle 2. Conclusions: Over a 6-month period, we improved OOE and documentation by meeting our goal of increasing the number of documented components from 40% to 82%. Review of processes with stakeholders is imperative to practice improvement. Implementation of an EHR tool is an easy way to improve quality standardized OOE and has the potential to increase OO adherence and decrease toxicity.

Current trends in training in continuing education: theoretical principles

The article supports the theoretical-methodological provisions that allow a systematic and comprehensive study of the postgraduate pedagogical training of teachers. The essence and characteristics of postgraduate pedagogical training for teachers from various training institutions were defined, providing professional and pedagogical training for this category of pedagogical staff; regularities, principles and conditions were developed for the implementation of promising directions for the development of the postgraduate pedagogical training system for teachers of different profiles; ifdeveloped technological support for postgraduate education for teachers from different backgrounds; promising paths for the development of postgraduate pedagogical training for teachers of multidisciplinary training in professional education were identified and based on the modernization of society.

National analysis of the Modified Monash Model, population distribution and a socio-economic index to inform rural health workforce planning.

To describe the population distribution and socio-economic position of residents across all states and territories of Australia, stratified using the 7 Modified Monash Model classifications. The numerical summary, and the methods described, can be applied by a variety of end users including workforce planners, researchers, policy-makers and funding bodies for guiding future investment under different scenarios, and aid in evaluating geographically focused programs. The Commonwealth Department of Health is transitioning to the Modified Monash Model to objectively describe geographical access. This change applies to the Rural Health Multidisciplinary Training Program, one of the Australian Government's key policies to address the maldistribution of the rural health workforce. Unlike the previously applied Australian Statistical Geography Standard-Remoteness Areas, a summary of the population in each Modified Monash Model classification is not available, nor is a socio-economic overview of the communities within these areas. Spatial analysis of Australian Bureau of Statistics data (Modified Monash Model, population data and the Index of Relative Socio-economic Advantage and Disadvantage collected or derived from the 2016 census) at the Statistical Area 1-the smallest unit for the release of census data. Linking the Modified Monash Model, a socio-economic index and granular population data at the national level highlights the disadvantage of many residents in small rural towns (Modified Monash 5). The Modified Monash Model does not exhibit a continuum of the largest population residing in the most accessible classification and the smallest population residing in the least accessible classification that is seen in the Australian Statistical Geography Standard-Remoteness Areas. Coupled with policy relevance, the advantage of using the Modified Monash Model as the basis for analysis is that it highlights areas that have both a critical mass of residents and differing levels of socio-economic advantage and disadvantage. This will help end users to target funding to those regions where there is potential to improve access to services for the greatest number of rural residents.

A Curriculum Model for Multidisciplinary Training of Midwife Sonographers in a Low Resource Setting.

In many low-resource settings, less than 5% of pregnant women can access ultrasound during pregnancy. Thus, gestational age is often difficult to determine, multiple pregnancies are diagnosed late and foetal and pregnancy-related anomalies can go undetected. A pilot solution was designed beyond the traditional approach of increasing numbers of qualified radiologists, gynaecologists and sonographers. An innovative Human Resource for Health (HRH) task sharing, and maternal child health (MCH) workforce training and capacity building initiative was designed, involving development and testing of a curriculum to train midwife sonographers via a teleradiology innovation platform and a partnership between specialist radiologists, sonographers and midwives. The setting was a tertiary-level private university hospital in Nairobi with implementation in three outreach locations. Direct oversight, support and supervision of specialist radiologists and ultrasonographers effectively addressed issues of quality and safety across the 3-week training period and project implementation. Concepts from sociocultural learning theory informed an initial interactive e-learning module for each midwife at their respective site. Midwives were introduced to ultrasound equipment with a series of didactic and interactive lectures delivered by an expert sonographer at the tertiary hospital teaching site. Lectures were supported by hands-on practical experience, role modelling and mentoring over a four-week period. Assessments included both written examination and practical assessment with an exit examination requiring demonstration of competency in both written and practical format. Final confirmation of scanning accuracy was confirmed with post-delivery verification of results. The pilot was highly successful with an image interpretation accuracy of 99.63% for the midwives. Lessons from this initiative provides guidance in the curriculum development process along with a curriculum outline; pedagogical framework; teaching methods; assessment processes; credentialing; resourcing; and other considerations in scaling up the program. Importantly, the paper details processes for maintaining a high level of quality control and patient safety.

Development of a psychosocial oncology core curriculum for multidisciplinary education and training: Initial content validation using the modified Delphi Method.

Despite its four decade history, the multidisciplinary specialty of psychosocial oncology (PSO) has no official consensus on core content. In 2014, the American Psychosocial Oncology Society (APOS) Board charged the APOS Professional Education Committee with outlining curricular content needed for core competence. Content validation was completed using a four-phase modified Delphi Method. During Phase I, a Professional Education Committee subgroup proposed domains and items, which were rated by the APOS Fellows and Board via online survey. During Phase II, Fellows completed a second, revised survey. Phase III incorporated early career members. Developmental and diversity items were integrated into each domain. In Phase IV, a larger group of subject matter experts were surveyed, with feedback incorporated. Validation across phases involved average rating thresholds, intraclass correlations, and final percent agreement. The Delphi Method supported 12 content domains: Cancer Basics, Psychosocial Oncology, Professional Development, Ethics, Emotional/Psychological Concerns, Sexuality and Relationship Concerns, Spiritual/Religious Concerns, Healthcare Communication and Decision Making, Social/Practical Problems, Caregiver Concerns, Cognitive Concerns, Physical Symptoms and Psychosocial Assessment/Treatment. High levels of agreement were achieved across domains (86%-100%) and items, with no significant rating differences by discipline. This proposed core content can enhance and standardize education and training in PSO including APOS' Virtual Psychosocial Oncology Core Curriculum, focused on broadly expanding the PSO workforce, particularly in underserved areas. Next steps include development of core competencies and establishment of online training modules based on this content validation.

Provider and administrator-level perspectives on strategies to reduce fear and improve patient trust in the emergency department in times of heightened immigration enforcement.

Heightened immigration enforcement may induce fear in undocumented patients when coming to the Emergency Department (ED) for care. Limited literature examining health system policies to reduce immigrant fear exists. In this multi-site qualitative study, we sought to assess provider and system-level policies on caring for undocumented patients in three California EDs. We recruited 41 ED providers and administrators from three California EDs (in San Francisco, Oakland, and Sylmar) with large immigrant populations. Participants were recruited using a trusted gatekeeper and snowball sampling. We conducted semi-structured interviews and analyzed the transcripts using constructivist grounded theory. We interviewed 10 physicians, 11 nurses, 9 social workers, and 11 administrators, and identified 7 themes. Providers described existing policies and recent policy changes that facilitate access to care for undocumented patients. Providers reported that current training and communication around policies is limited, there are variations between who asks about and documents status, and there remains uncertainty around policy details, laws, and jurisdiction of staff. Providers also stated they are taking an active role in building safety and trust and see their role as supporting undocumented patients. This study introduces ED-level health system perspectives and recommendations for caring for undocumented patients. There is a need for active, multi-disciplinary ED policy training, clear policy details including the extent of providers' roles, protocols on the screening and documentation of status, and continual reassessment of our health systems to reduce fear and build safety and trust with our undocumented communities.

4D Printing Classroom in Modern Interactive Learning Environments

The emergence of four-dimensional (4D) printing and bioprinting in additive manufacturing (AM), which require knowledge of multi-physics, chemistry, and engineering skills, are bringing many engineering applications in biomedical devices, wearables, and robotics. This newly emerging technology has become a feasible commercial proposition because of lower costs, more design freedom, and more rapid production methods. This serves as a significant multidisciplinary research and training platform for both academia and the professional world. This work aims at enhancing researchers’ interest, knowledge, and skills in the emerging field of 4D printing and bioprinting. A greater knowledge of 4D printing and promotion of its practices enables students to pursue research and applications that 4D printing may offer. Therefore, a straightforward step-by-step approach, including design, metaphysics modeling principles, finite element method (FEM) simulation, and minimum facilities to replicate 4D bioprinting as part of an interdisciplinary unit in class, is presented in this study.

Kebijakan Kepala Madrasah dalam Meningkatkan Kompetensi Profesional Guru di MI NW Lendang Ara

This research aims to find out how the head of MADRASAH MI NW Lendang Ara made a policy in improving the professional competence of teachers. Policy is the fundamental basis for carrying out something with a specific purpose. This study uses qualitative, namely research conducted descriptively and analyze fe-nomena, events, social activities, attitudes, beliefs and perspectives of each person or group, while the data collection in this study using observations and interviews. This research was conducted at MI NW Lendang Ara, Kec. Kopang Central Lombok. In improving the professional competence of teachers the head of madrasah MI NW Lendang ara makes policies to make teacher training such as holding seminars, supervision, multi-disciplinary training and giving awards for teachers who excel and give freedom to teachers in developing themselves to increase their potential.

Multidisciplinary Simulation Training for Surgical Tracheostomy in Patients Mechanically Ventilated Secondary to Severe Acute Respiratory Syndrome Coronavirus 2.

A proportion of patients with coronavirus disease (COVID) and severe respiratory manifestations of disease will require admission to intensive care for intubation and ventilation. When anticipating prolonged ventilation, the patient may proceed to surgical tracheostomy to afford safe respiratory wean. As surgical tracheostomy is an aerosol-generating procedure, it poses a high risk of viral transmission and ultimately may prompt anxiety and caution in participating staff members. We aimed to mitigate these risks by providing staff with appropriate training and experience, to improve their confidence as well as practical ability. We developed a multidisciplinary simulation training experience and checklist in order to optimize team performance during the high-stakes procedure. We evaluated staff confidence before and after the training with questionnaires. Post-simulation, surgeons were more confident with donning the high level personal protective equipment, and nurses were more confident in performing their role. Simulation allows the multidisciplinary team an opportunity to practice high-risk procedures and prompts the team to assess staff knowledge base, troubleshoot queries, and teach roles and responsibilities in a safe environment. In the context of COVID-19, simulation encourages staff sense of preparedness and protection for true participation during a high-risk procedure.