Simulation-based Training Course Research Articles

Simulation-based training in Ebola Personal Protective Equipment for healthcare workers: Experience from King Abdulaziz University Hospital in Saudi Arabia.

Millions of Muslims from across the world gather annually to perform pilgrimage. This can import unusual communicable diseases such as Ebola. Communicable diseases with a high risk of mortality necessitate special training to master the required competency to avert transmission of infections. The efficacy of simulation-based training (SBT) has been shown in such circumstances. We sought to develop an SBT program in Ebola Personal Protective Equipment (PPE) for all healthcare workers (HCWs). We conducted a quasi-experimental study at the clinical skills and simulation center at the King Abdulaziz University. An interdisciplinary committee was formed to develop this program in three stages. Pre-intervention: Needs assessment "Diagnostic drill"; we conducted in-situ simulation in the emergency department (ED). High-fidelity simulator (HFS) was used as a suspected Ebola case to assess HCWs' competency of PPE. We used a checklist that was developed in accordance with the national and international guidelines. We then conducted "Train the Trainer in Ebola PPE" course to develop potential instructors. PPE competency SBT courses. This involved focusing on trainees to be skilled in Ebola PPE and becoming trained observers using skill stations and Ebola scenario with HFS, followed by debriefing. All courses gathered participants' evaluations, pre, and post-tests. Post-intervention: In-situ simulation in the ED two months later that was similar to the diagnostic drill. Pre-intervention: 7 HCWs were involved in the drill, the average score was 37% of the checklist items. For train the trainer, 19 potential PPE instructors attended the program; of them, 65% were female and 35% male, and 6 were physicians and 13 nurses. Average pre and post-tests scores were 72% and 86%, respectively. 10 PPE courses that were attended by 179 HCWs; of them, 67% were female and 33% male, and 52 were physicians, 112 nurses, and 15 others. Pre and posttests were 67% (57-75%) and 85% (81-91%), respectively, with a p-value<0.01. Post-intervention: Post Program drill's average score was 86% of the checklist items (37% in diagnostic drill). Using SBT could be an effective method of developing competent HCWs in Ebola PPE.

Safe transfer of simulation-based intubation skills to patients in cardiac arrest

Background: Studies investigating the transfer of endotracheal intubation skills from simulation training to out-of-hospital patient scenarios are limited. Aims: The aim was to evaluate the outcome of endotracheal intubation simulation training among paramedics and the safe transfer of skills to out-of-hospital cardiac arrest (OHCA) patients. Methods: Paramedics participated in a 1-day simulation training course including five Airtraq endotracheal intubation attempts using three different types of mannequins (n=15 attempts). Performance and outcome of transfer of intubation skills to patients were monitored for the next 35 months. European Resuscitation Council international advanced cardiopulmonary resuscitation guidelines ( Nolan et al, 2005 ) were followed to ensure patient safety. Findings: Endotracheal intubation was attempted in a total of 417 patients with OHCA by 51 (96%) of the 53 participating paramedics. In 366 (88%) patients, intubation was successfully performed in the first or second attempt. Aspiration, airway secretion, a high modified Cormack Lehane score and insecure verification of tube placement were the most common reasons for failed intubation. Conclusion: Endotracheal intubation with Airtraq in adult patients with OHCA can be performed safely by paramedics after receiving a 1-day simulation-based training course.

A Validation Argument for a Simulation-Based Training Course Centered on Assessment, Recognition, and Early Management of Pediatric Sepsis.

Early recognition of sepsis remains one of the greatest challenges in medicine. Novice clinicians are often responsible for the recognition of sepsis and the initiation of urgent management. The aim of this study was to create a validity argument for the use of a simulation-based training course centered on assessment, recognition, and early management of sepsis in a laboratory-based setting. Five unique simulation scenarios were developed integrating critical sepsis cues identified through qualitative interviewing. Scenarios were piloted with groups of novice, intermediate, and expert pediatric physicians. The primary outcome was physician recognition of sepsis, measured with an adapted situation awareness global assessment tool. Secondary outcomes were physician compliance with pediatric advanced life support (PALS) guidelines and early sepsis management (ESM) recommendations, measured by two internally derived tools. Analysis compared recognition of sepsis by levels of expertise and measured association of sepsis recognition with the secondary outcomes. Eighteen physicians were recruited, six per study group. Each physician completed three sepsis simulations. Sepsis was recognized in 19 (35%) of 54 simulations. The odds that experts recognized sepsis was 2.6 [95% confidence interval (CI) = 0.5-13.8] times greater than novices. Adjusted for severity, for every point increase in the PALS global performance score, the odds that sepsis was recognized increased by 11.3 (95% CI = 3.1-41.4). Similarly, the odds ratio for the PALS checklist score was 1.5 (95% CI = 0.8-2.6). Adjusted for severity and level of expertise, the odds of recognizing sepsis was associated with an increase in the ESM checklist score of 1.8 (95% CI = 0.9-3.6) and an increase in ESM global performance score of 4.1 (95% CI = 1.7-10.0). Although incomplete, evidence from initial testing suggests that the simulations of pediatric sepsis were sufficiently valid to justify their use in training novice pediatric physicians in the assessment, recognition, and management of pediatric sepsis.

Simulation-based Team Training for Multiprofessional Obstetric Care Teams to Improve Patient Outcome: A Multicentre, Cluster Randomized Controlled Trial

(BJOG. 2017;124:641–650) Simulation training is considered an important component in medical education. It provides a more effective method for teaching technical skills through practice without risk to the patient. It has also been recommended for obstetric teams as a way to improve team performance and perhaps obstetric outcomes. Criteria for assessing simulation training has included participants’ perceptions of the simulation experience, assessment of knowledge and skills during and after simulation, subsequent changes in clinical practice, and ultimately improvement in patient outcomes. However, data on the effect of simulation training on patient outcomes has been limited. This study looked at the effect of a 1-day simulation-based training course for obstetric teams on the rate of patient complications over a 1-year period.

A Review of Paracentesis Performance in Ascites Following Simulation-Based Training

Introduction: Guidelines recommend that a diagnostic paracentesis be performed in all patients with cirrhosis and ascites upon hospital admission. Paracentesis is often performed by internal medicine (IM) residents however few institutions have a formal training program. Delays in paracentesis >12 hours have also been linked to increased patient mortality. Methods: We implemented a simulation-based training (ST) course for IM residents to improve resident confidence and competence in paracentesis. 130 IM residents underwent ST which included precourse reading, small group discussions, and task training. We performed a retrospective review of all patients with ascites admitted in two 12-month periods, before and after ST at 2 academic teaching hospitals. The primary outcome was time from admission to paracentesis. Secondary outcomes included in-hospital mortality, hospital length of stay (LOS), and development of acute kidney injury (AKI). Results: A pre-course survey revealed that most residents had never performed a paracentesis, had little prior training and were not confident in performing paracentesis. A total of 678 charts were reviewed, and a total of 89 paracenteses were performed pre-ST and 65 post-ST. IM residents performed more paracenteses following ST (23.6% vs. 33.9%). The remainder were performed by interventional radiology (IR). Mean time to paracentesis decreased for housestaff (49.1h to 39.9h) and increased for IR (57.5h to 82.2h) after ST. IM residents were more likely to perform paracentesis on patients with higher MELD scores and rate of ICU admission (see Table). There was a statistically significant decrease in development of AKI in the resident cohort (47.6% to 18.2%, p= 0.04) and remained unchanged in the IR-cohort (32.4% to 34.9%). Mean hospital LOS and in-hospital mortality decreased in the resident cohort, while they remained unchanged and increased in the IR-cohort (see Table).Table: Table. Results of Paracentesis Performance Following Simulation-Based TrainingConclusion: Our study shows that after implementation of a simulation-based paracentesis course, IM residents performed a greater proportion of procedures, a decreased time to paracentesis, and had improved patient outcomes. ST improved resident confidence in performing paracentesis and this likely explains the increase in procedures performed by them and in higher acuity patients. Increase in clinical knowledge post-ST regarding paracentesis may explain decreased time to procedure, lower rates of AKI, decreased hospital LOS, and in-hospital mortality seen in the post-intervention period.

Assessment tool for the instructional design of simulation-based team training courses: the ID-SIM.

To achieve an expert performance of care teams, adequate simulation-based team training courses with an effective instructional design are essential. As the importance of the instructional design becomes ever more clear, an objective assessment tool would be valuable for educators and researchers. Therefore, we aimed to develop an evidence-based and objective assessment tool for the evaluation of the instructional design of simulation-based team training courses. A validation study in which we developed an assessment tool containing an evidence-based questionnaire with Visual Analogue Scale (VAS) and a visual chart directly translating the results of the questionnaire. Psychometric properties of the assessment tool were tested using five descriptions of simulation-based team training courses. An expert-opinion-based ranking from poor to excellent was obtained. Ten independent raters assessed the five training courses twice, by using the developed questionnaire with an interval of 2 weeks. Validity and reliability analyses were performed by using the scores from the raters and comparing them with the expert's ranking. Usability was assessed by an 11-item survey. A 42-item questionnaire, using VAS, and a propeller chart were developed. The correlation between the expert-opinion-based ranking and the evaluators' scores (Spearman correlation) was 0.95, and the variance due to subjectivity of raters was 3.5% (VTraining*Rater). The G-coefficient was 0.96. The inter-rater reliability (intraclass correlation coefficient (ICC)) was 0.91 (95% CI 0.77 to 0.99), and intra-rater reliability for the overall score (ICC) was ranging from 0.91 to 0.99. We developed an evidence-based and reliable assessment tool for the evaluation of the instructional design of a simulation-based team training: the ID-SIM. The ID-SIM is available as a free mobile application.

Implementation of a novel portfolio of structured, curriculum-aligned, simulation-based, cardiothoracic surgery training courses: Evolving the delivery of surgical education

ObjectiveThe provision of high-quality cardiothoracic surgical training faces many challenges. This has generated an increased interest in simulation-based learning, which can provide a less stressful environment for deliberate practice. We developed a comprehensive, structured program of knowledge and simulation-based learning aligned to the official cardiothoracic surgery curriculum. MethodsA portfolio of 10 curriculum-aligned training courses was designed for cardiothoracic surgical trainees during their 6-year training program. The courses were delivered through a multitude of education methods, including live porcine operating simulation models, and were evaluated through a series of quantitative (5-point Likert-scale) and qualitative assessments. The trainees (n = 15-21 per course) also completed pre- and postsession self-confidence and competency levels for each training episode of knowledge and skill, respectively. In addition, board examination pass rates were assessed in the 3-year periods before and after implementation of the courses. ResultsQuantitative analysis of the trainees' feedback demonstrated an extremely positive view of the portfolio of the simulation-based training courses with excellent satisfaction scores (out of 5) for teaching sessions (4.44 ± 0.07), faculty (4.64 ± 0.07), content and materials (4.63 ± 0.07), and facilities (4.73 ± 0.05). The courses have shown a significant improvement in the post–self-confidence (7.98 ± 0.13 vs 5.62 ± 0.20, P < .01) and perceived self-competency (8.10 ± 0.10 vs 5.67 ± 0.11, P < .01) scores for all courses. Examination pass rates significantly improved in the 3-year period after attendance at the courses (94.82% ± 2.34% vs 76.26% ± 3.23%, P < .005). ConclusionsThis study has described the implementation of the only extensive program of structured simulation-based courses that has been developed to complement clinical training in cardiothoracic surgery.

Simulation-based team training improved the self-assessed ability of physicians, nurses and midwives to perform neonatal resuscitation.

The use of simulation-based team training in neonatal resuscitation has increased in Sweden during the last decade, but no formal evaluation of this training method has been performed. This study evaluated the effect of simulation-based team training on the self-assessed ability of personnel to perform neonatal resuscitation. We evaluated a full-day simulation-based team training course in neonatal resuscitation, by administering a questionnaire to 110 physicians, nurses and midwives before and after the training period. The questionnaire focused on four important domains: communication, leadership, confidence and technical skills. The study was carried out in Sweden from 2005 to 2007. The response rate was 84%. Improvements in the participants' self-assessed ability to perform neonatal resuscitation were seen in all four domains after training (p < 0.001). Professionally inexperienced personnel showed a significant improvement in the technical skills domain compared to experienced personnel (p = 0.001). No differences were seen between professions or time since training in any of the four domains. Personnel with less previous experience with neonatal resuscitation showed improved confidence (p = 0.007) and technical skills (p = 0.003). A full-day course on simulation-based team training with video-supported debriefing improved the participants' self-assessed ability to perform neonatal resuscitation.

Sharing simulation-based training courses between institutions: opportunities and challenges

BackgroundSharing simulation-based training (SBT) courses between institutions could reduce time to develop new content but also presents challenges. We evaluate the process of sharing SBT courses across institutions in a mixed method study estimating the time required and identifying barriers and potential solutions.MethodsTwo US academic medical institutions explored instructor experiences with the process of sharing four courses (two at each site) using personal interviews and a written survey and estimated the time needed to develop new content vs implement existing SBT courses.ResultsThe project team spent approximately 618 h creating a collaboration infrastructure to support course sharing. Sharing two SBT courses was estimated to save 391 h compared with developing two new courses. In the qualitative analysis, participants noted the primary benefit of course sharing was time savings. Barriers included difficulty finding information and understanding overall course flow. Suggestions for improvement included establishing a standardized template, clearly identifying the target audience, providing a course overview, communicating with someone familiar with the original SBT course, employing an intuitive file-sharing platform, and considering local culture, context, and needs.ConclusionsSharing SBT courses between institutions is feasible but not without challenges. An initial investment in a sharing infrastructure may facilitate downstream time savings compared with developing content de novo.

Simulated settings; powerful arenas for learning patient safety practices and facilitating transference to clinical practice. A mixed method study.

Poor teamwork is an important factor in the occurrence of critical incidents because of a lack of non-technical skills. Team training can be a key to prevent these incidents. The purpose of this study was to explore the experience of nursing and medical students after a simulation-based interprofessional team training (SBITT) course and its impact on professional and patient safety practices, using a concurrent mixed-method design. The participants (n=262) were organized into 44 interprofessional teams. The results showed that two training sequences the same day improved overall team performance. Making mistakes during SBITT appeared to improve the quality of patient care once the students returned to clinical practice as it made the students more vigilant. Furthermore, the video-assisted oral debriefing provided an opportunity to strengthen interprofessional teamwork and share situational awareness. SBITT gave the students an opportunity to practice clinical reasoning skills and to share professional knowledge. The students conveyed the importance of learning to speak up to ensure safe patient practices. Simulated settings seem to be powerful arenas for learning patient safety practices and facilitating transference of this awareness to clinical practice.

The effect of a multidisciplinary obstetric emergency team training program, the In Time course, on diagnosis to delivery interval following umbilical cord prolapse – A retrospective cohort study

Cord prolapse is an uncommon obstetric emergency, with potentially fatal consequences for the baby if prompt action is not taken. Simulation training provides a means by which uncommon emergencies can be practised, with the aim of improving teamwork and clinical outcomes. This study aimed to determine if the introduction of a simulation-based training course was associated with an improvement in the management of cord prolapse, in particular the diagnosis to delivery interval. We also aimed to investigate if an improvement in perinatal outcomes could be demonstrated. A retrospective cohort study was performed. All cases of cord prolapse in the designated time period were identified and reviewed and a comparison of outcome measures pre- and post-training was undertaken. Thirty-one cases were identified in the pre-training period, and compared to 64 cases post-training. Documentation improved significantly post-training. There were non-significant improvements in use of spinal anaesthetic, and in the length of stay in the special care neonatal unit. There was a significant increase in the number of babies with Apgar scores less than seven at 5min. There were no differences in the diagnosis to delivery interval, or in perinatal mortality rates. Obstetric emergency training was associated with improved teamwork, as evidenced by the improved documentation post-training in this study, but not with improved diagnosis to delivery interval. Long-term follow-up studies are required to ascertain whether training has an impact on longer-term paediatric outcomes, such as cerebral palsy rates.

Simulation-Based Training - Evaluation of the Course Concept "Laparoscopic Surgery Curriculum" by the Participants.

The learning curve in minimally invasive surgery is much longer than in open surgery. This is thought to be due to the higher demands made on the surgeon's skills. Therefore, the question raised at the outset of training in laparoscopic surgery is how such skills can be acquired by undergoing training outside the bounds of clinical activities to try to shorten the learning curve. Simulation-based training courses are one such model. In 2011, the surgery societies of Germany adopted the "laparoscopic surgery curriculum" as a recommendation for the learning content of systematic training courses for laparoscopic surgery. The curricular structure provides for four 2-day training courses. These courses offer an interrelated content, with each course focusing additionally on specific topics of laparoscopic surgery based on live operations, lectures, and exercises carried out on bio simulators. Between 1st January, 2012 and 31st March, 2016, a total of 36 training courses were conducted at the Vivantes Endoscopic Training Center in accordance with the "laparoscopic surgery curriculum." The training courses were attended by a total of 741 young surgeons and were evaluated as good to very good during continuous evaluation by the participants. Training courses based on the "laparoscopic surgery curriculum" for acquiring skills in laparoscopy are taken up and positively evaluated by young surgeons.

Neonatal Resuscitation Training: Implications of Course Construct and Discipline Compartmentalization on Role Confusion and Role Ambiguity.

The Neonatal Resuscitation Program's (NRP's) Sixth Edition introduced simulation-based training (SBT) into neonatal life support training. SBT offers neonatal emergency response teams a safe, secure environment to rehearse coordinated neonatal resuscitations. Teamwork and communication training can reduce tension and anxiety during neonatal medical emergencies. To discuss the implications of variability in number and type of simulation scenario, number and type of learners who comprise a course, and their influence upon scope of practice, role confusion, and role ambiguity. Relevant articles from MEDLINE, CINAHL, EMBASE, Google Scholar, the World Health Organization, the American Heart Association, and NRP were included in this integrative review of the literature. Purposeful synergy of optimal SBT course construct with teamwork and communication can resist discipline compartmentalization, role confusion, and role ambiguity. Five key themes were identified and coined the "5 Rights" of NRP SBT. These "5 Rights" can guide healthcare institutions with planning, implementation, and evaluation of NRP SBT courses. NRP SBT can facilitate optimal team function and reduce errors when teams of learners and varied scenarios are woven into the course construct. The simulated environment must be realistic and fully equipped to encourage knowledge transfer and attainment of the NRP's key behavioral outcomes. Investigation of teamwork and communication training with NRP SBT, course construct, discipline compartmentalization, and behavioral and clinical outcomes is indicated. Investigation of outcomes of SBT using a team-teaching model, combining basic and advanced practice NRP instructors, is indicated.

Baseline Laparoscopic Skill May Predict Baseline Robotic Skill and Early Robotic Surgery Learning Curve.

Robotic surgery is associated with a learning curve unique to each trainee. Knowledge about a trainee's baseline skill and learning curve would facilitate the development of a more individualized training curriculum. The aim of our study was to determine whether baseline laparoscopic skill is predictive of one's baseline robotic skill and short-term learning curve. Trainees from four different surgical specialties were included in the study. Each trainee participated in a 4-week, simulation-based robotic surgery basic skills training course. Precourse, baseline laparoscopic and robotic skills were assessed using validated test tasks; a basic peg transfer (PT) and an advanced intracorporeal suturing and knot tying (ISKT) task. Trainee robotic skill was assessed again 1 week postcourse. Each task performance was video recorded and scored by two blinded expert surgeons. A total of 32 trainees were included; 14 urology, 7 gynecology, 8 thoracic Sx, 3 general Sx. Most (91%) were senior residents or clinical fellows and 50% had no prior robotic experience. There were no differences in baseline laparoscopic and robotic skill related to reported prior robotic experience. Between specialties, no differences were seen on baseline laparoscopic skill and only small differences were seen on baseline robotic skill. Both baseline Lap PT (p = 0.01) and Lap ISKT (p = 0.01) performances correlated with baseline robotic ISKT performance, but not robotic PT scores. Only baseline Lap ISKT performance correlated with postcourse robotic PT (p = 0.01) and ISKT (p < 0.01) performance. Baseline robotic ISKT scores, but not PT scores, correlated with postcourse robotic performance (p = 0.02 for PT, p < 0.01 for ISKT). In this study, a trainee's baseline laparoscopic skill correlated with certain baseline robotic skills. Better baseline performance on an advanced, but not basic, laparoscopic and robotic skill task may correlate with a shorter learning curve for basic robotic skills. Further exploration of this finding may yield better training curricula.

麻酔科が提供する鎮静管理の医療安全─SED実践セミナーの臨床応用─

われわれは，SED実践セミナー（セデーショントレーニングコース）を鎮静管理に関する医療安全の向上と教育を目的として開発した．開発時には，米国麻酔科学会（ASA）による非麻酔科医のための鎮静・鎮痛ガイドラインを基本として，非麻酔科医を取り巻く鎮静の現状を調査した．さらに，学習目標を各パートにおいて策定し，プレ・ポストテスト導入による学習効果の評価やアンケートを用いたSED実践セミナーによる行動変容も検討した．また，各専門領域に対するコース開発やJoint Commission Internationalへの対応も視野に入れた展開を行っている．今後も，鎮静の医療安全管理向上のための柔軟に変化し成長するコースとしてSED実践セミナーの役割が期待される．

Abstract 15595: Improved Clinical Performance and Teamwork of Pediatric Interprofessional Resuscitation Teams With a Simulation-Based Educational Intervention

Introduction: Human errors occur during resuscitation despite individual knowledge of resuscitation guidelines. Poor teamwork has been implicated as a major source of such error; therefore interprofessional resuscitation teamwork training is essential. Hypothesis: A one-day team training course for pediatric interprofessional resuscitation team members improves adherence to PALS guidelines, team efficiency and teamwork in a simulated clinical environment. Methods: A prospective interventional study was conducted at 4 children’s hospitals in Canada with pediatric resuscitation team members (n=300, 51 teams). Educational intervention was a one-day simulation-based team training course involving interactive lecture, group discussions and 4 simulated resuscitation scenarios followed by debriefing. First scenario of the day was conducted prior to any training. Final scenario of the day was the same scenario, with modified patient history. Scenarios included standardized distractors designed to elicit and challenge specific teamwork behaviors. Primary outcome measure was change (before and after training) in adherence to PALS guidelines, as measured by the Clinical Performance Tool (CPT). Secondary outcome measures: change in times to initiation of chest compressions and defibrillation; and teamwork performance, as measured by the Clinical Teamwork Scale (CTS). Correlation between CPT and CTS scores was analyzed. Results: Teams significantly improved CPT scores (67.3% to 79.6%, P&lt; 0.0001), time to initiation of chest compressions (60.8 sec to 27.1 sec, P&lt;0.0001), time to defibrillation (164.8 sec to 122.0 sec, P&lt;0.0001) and CTS scores (56.0% to 71.8%, P&lt;0.0001). Significantly more teams defibrillated under AHA target of 2 minutes (10 vs. 27, P&lt;0.01). A strong correlation was found between CPT and CTS (r=0.530, P&lt;0.0001). Conclusions: Participation in a simulation-based team training educational intervention significantly improved surrogate measures of clinical performance, time to initiation of key clinical tasks, and teamwork during simulated pediatric resuscitation. A strong correlation between clinical and teamwork performance suggests that effective teamwork optimizes clinical performance of resuscitation teams.

PWE-434 Evaluation of the impact of the learning context on the acquisition of complex professional skills through simulation based training courses

Introduction Rates of upper gastrointestinal pathology requiring diagnostic and therapeutic intervention in Southern Malawi are high, resources and endoscopy services are limited, and there are very few independently practicing endoscopists. Endoscopy is recognised to be a complex cognitive and technical skill that requires a dedicated period of training to achieve proficiency. An endoscopy-training programme developed for UK trainees that includes simulation, was introduced to Malawi in 2009. This study explores the commonalities and differences in the way simulation training was experienced and made use of by endoscopy trainees in both countries. It also explores what modifications are needed to make current courses maximally beneficial in a resource limited environment. Method Trainees and trainers from the UK and Malawi were invited to participate in semi-structured interviews. During the interview trainees were asked to describe the structure of their endoscopy training, experiences of simulation training and outline perceived benefits and drawbacks of their programme. Trainers were asked about their views on endoscopy training, experiences as course faculty and any modifications they felt were necessary to current training programmes to make them maximally beneficial in each country. Interview data was transcribed in full and analysed using a thematic analysis approach. Results 17 people participated in the study: 4 trainers (3 with experience of training in Europe and Malawi), 2 Endoscopy sisters and 11 trainees (4 from Malawi and 7 from the UK – two of the Malawi trainees subsequently became local trainers). Although there were considerable differences in the learning environment between the UK and Malawi, trainees recognised simulation based endoscopy-training courses as an important opportunity for intensive skill based training, which supplemented their on-going departmental endoscopy training. Factors that improved the trainee learning experience during the courses included: being taught by skilled trainers; trainees identifying a need or clinical application for their endoscopy training; and course design, specifically having access to simulation models prior to being exposed to live cases. Suggested modifications to the training programme in Malawi included; implementing robust candidate selection to prevent “drop-out” from the training programme and improving local equipment. Conclusion UK designed simulation based endoscopy-training courses were well received by Malawian trainees and needed only minor modification to be applicable and beneficial in their new environment. Disclosure of interest None Declared.

G554(P) Implementation of an integrated inpatient paediatric mortality reduction intervention

Background Based at a University teaching hospital in Northern Ethiopia, the author was placed through Voluntary Services Oversea’s (VSO) as a Paediatric Senior. The department witnesses a high Paediatric mortality rate amongst inpatients (30%, non-neonatal). Ward level care is largely provided by junior doctors (Interns). A gap in knowledge and skills of up-to-date resuscitation practices was identified in this group. Project design The project included an intervention to improve Intern knowledge and skills. The intervention comprised development of a resuscitation protocol package with suitable training. A baseline audit of all Paediatric admissions (excluding neonates) over a three month period provided mortality data including specifics of disease category. This highlighted the conditions with highest rates of mortality at our hospital: severe acute malnutrition, coma, meningitis, congestive heart failure (CHF), hypovolaemic shock and meningitis. The Paediatric senior faculty developed five, locally appropriate, protocols to address the acute management of these conditions plus added three complementary protocols based on those promoted by the Emergency Triage, Assessment and Treatment (ETAT), WHO. The final protocol package included: respiratory distress, hypovolaemic shock, septic shock, coma, CHF, airway emergencies, seizure and cardio-pulmonary resuscitation (CPR). The nuances of acute malnutrition were addressed in each protocol. The package provided readily available, locally appropriate guidelines to provide evidence based information for Interns. The protocol package was implemented with a training programme of all Interns rotating through the Paediatric department during the study period (n = 21, September 6th to December 9th 2011). A full day simulation based training course was developed to introduce the concept and use of the protocol package plus development of key resuscitation skills: bag mask ventilation, CPR plus intra-osseous needle placement. Simulation based scenarios were developed to build on theoretical knowledge provided in short didactic lectures and allow practice of skills. Results 474 patients were admitted in the baseline group and 432 following the intervention. No change was observed for overall mortality (crude OR=0.72, 95% CI 0.40–1.29, p = 0.265). No change was observed in first-24-hour mortality (crude OR 0.97, 95% CI 0.37–2.55, p = 0.959). Total examination scores improved from median 32.6 to 73.5% (p Evaluation Two aspects were evaluated to aid measurement of success. An audit of inpatient admissions was carried out pre and post Intern training. Data was collected from the ward log book and entered into an Excel spreadsheet. The primary and secondary outcomes included crude mortality plus mortality within the first 24 h and were expressed as a percentage of admissions. Odds ratios for these outcomes were calculated using univariable logistic regression. Evaluation of Intern knowledge and skills took place pre- and post-training to assess the impact of the simulation based program. Testing took place in multiple choice format with videos of critically ill children to focus on pattern recognition and triage skills plus a theory paper to assess problem-solving in emergency situations. Procedural skills were tested by direct observation. Trainees were asked to demonstrate skills covered in the course while project coordinators applied a standardised, checklist-based marking tool to evaluate their performance. Median trainee examination scores were calculated as percentage answered correctly and pre- and post-training results were compared by Wilcoxon matched-pairs signed ranks test. Conclusions Combining care standardisation, management protocols, and simulation-based training did not red uce mortality among non-neonatal Paediatric inpatients in this study. Simulation-based training improved short-term test performance among Ethiopian medical trainees.

鎮静の医療安全向上へのシミュレーション教育の活用─大阪医科大学附属病院医療総合研修センターの試み─

鎮静の医療安全向上へのシミュレーション教育の活用─大阪医科大学附属病院医療総合研修センターの試み─

Board #200 - Program Innovation Development of a Multi-disciplinary Simulation-based Training Course for the Safe High Acuity Adult Retrieval Programme (SHAARP) (Submission #9978)

Board #200 - Program Innovation Development of a Multi-disciplinary Simulation-based Training Course for the Safe High Acuity Adult Retrieval Programme (SHAARP) (Submission #9978)