Outline

1. From APLS courses toadvancedsimulation training: A tale of ourjourneyJos Draaisma & Ester Coolen

2. Outline • To start with APLS • Teaching pediatricemergencies:Whydo we needsimulation as aneducational tool? • Prerequisitesfor transfer of training: How can we enhancetranfer of skills intodailyclinicalpractice? • The importance of teaching team skills: How can we train andassesteamskills? • Situationalleadership – Followership • Situationalawareness • Challangesforourfuture training program

3. What is the purpose of APLS courses? Toimprove the acute medical care byindividualphysiciansand / or nurses of severlyill or traumatizedchildrenbyimproving primary assessment / survey resuscitation secondary assessment (sometimes) emergency treatment definitive treatment

4. What is the effect of APLS courses?Kirkpatrick’s Levels of Learning Level 1: Reaction Level 2: Learning Level 3: Behavioural change Level 4: Organisational performance

5. Level 1: Self-efficacy Turner et al

6. Level 3: Behavioural change Turner et al

7. From a team of experts toan expert team

8. Members of pediatric teams are expected to share a common goal, also called a “shared mental model “ Although team members are sufficiently trained individually; team work skills have traditionally been less emphasized in medical training

9. Features of high fidelitymedicalsimulation “It’s OK, this is a teaching hospital. Some people just have to learn the hard way” • Providing feedback • Repetitivepractice • Curriculum integration • Variety of clinicalconditions • Controlled safe environment • Individualisedlearning (range of difficulty levels) • Definedoutcomes • Simulator validity Conclusion: High fidelitymedicalsimulations are effectiveand complement medicaleducation in patient care settings (Issenberg et al 2000) Howeverit’s anexpensivelearning tool andlittleevidencecomparing simulator based training to traditional educationalmodelsforpediatricemergencies

10. Additional value of VARS model over traditional educational models PBL EPLS VARS Effectiveness of high fidelityvideo-assistedreal-timesimulation: a comparison of three training methodsfor acute pediatricemergencies.Coolen EH & Draaisma JM, et al. • Scores on the post-interventionscenariosweresignificantlyhigherforallgroups • -The VARS-groupshowedsignificantly (p<0.05) higher scores on both post-intervention scenario’s in structureandtimelyachievement of critial actions

11. Human Factor Competencies Organization Technique de mens Environment Task SEIPS-model / Systems Engineering Initiave for Patient Safety Prof. Pascale Carayon / University of Winconsin – Madison - USA

12. ABCD PBLS Break Introductie simulator CRM principes CRM simulation Break CRM workshop VMS 1 simulation VMS 1 workshop Lunch Our Video Assisted Real Time Team Training Program 8.00 Lecture E-learning 8.15 Skill E-learning 9.00 9.30 skill 9.45 Lecture 10.15 simulation 11.00 11.15 workshop 11.45 simulation 12.30 workshop 13.00 VMS 2 simulation VMS 2 workshop Break VMS 3 simulation VMS 3 workshop End Debriefing 13.30 simulation 14.15 workshop 14.45 15.00 simulation 15.45 workshop 16.15 16.30 ABCD algorithms Basic Life Support Crew Resource Management (CRM) VMS 1:Recognition and treatement of criticallyillpatient VMS 2:Recognition and treatement of pain VMS 3:Prevention and treatement of sepsis VMS 4: High-riskmedication: preparing and administering intravenous medication and parental nutrition. VMS 5: Medicationverification

14. Prerequisites for training: Realism - The perspective of realism depends strongly on setting and learning goals (technical vs non-technical). - During STT team assembly and role playing can become more important to participants, while physical aspects become less important (semantical vs physical).

15. Prerequisites for training:Self-efficacy

16. Leadership skills

17. Skog et al, Teaching and LearningMedicine 2012

18. Leadershipstyle

21. Manage problems by predicting them instead of waiting for them to happen • Risk Profile for Clinical Deterioration • Elevated PEWS • High risk therapy • Family expresses concern • Communication breakdown • Gut feeling not expressed: “watcher”

23. Situation Awareness Global Assessment In VARS training • A simulation is frozen at randomlyselectedtimesandall professionals are queried as totheirperceptions of the simulation at that time • Scenario setting • Subacute deterioratingclinicalpatient • The scenario is stoppedfor 3 minutes and the monitor blanked • All professionals are askedtoanswer multiple choicequestionsabouttheircurrentperceptions of the situation, includingperception of data, perception of the problemandwhattheywouldliketo do • Debriefing with video and SAGAT input

24. Experienceswith SAGA The disturbanceby “freeze” is minimal: time-out canincreaseindividual SA Complementary SA of nurses may lead tomiscommunication Perception of leadershipdiffersbetweennusrsesandphysicians The mark for teamwork is mainlygiven as a consequence of the perception of importance of everybody’sowntask

25. For effective team work: Explicitelyimprovespeak-up Leadershipmaybecomposed of twotasks: hands-on (management) and hands-off (overview) Leadership is notonly the allocation of tasks, but also the evaluationandcorrection of individualandteamtasks Share alternativeswith the team

26. Challenges for our future training program Measuring Situational Awareness during Clinical Practice Training inter-professional teams: e.g. gynecologists, emergency physicians, pediatric surgeons Competition with other patient safety programs / government obligations Time and Money

27. Thank you for your attention