Wednesday, 30 April 2014

SCSN-ASPiH Symposium 2014: The triumphs and the challenges (by M Moneypenny)

Where's that Training Centre?
The second joint Scottish symposium organised by the Scottish Clinical Skills Network (SCSN) and the Association for Simulated Practice in Healthcare (ASPiH) took place on the 23rd and 24th April 2014.
The venue was the very impressive Uaill Scottish Fire & Rescue Service Training Centre in Glasgow. The Centre is new enough (officially opened in February 2013) that Google Maps still has tarmac and grass on the satellite view.


With perhaps a small nod to recency bias, this was one of the best conferences/symposia/meetings I have attended. The keynote speakers were excellent and the workshops I managed to attend were engaging, thought-provoking and a stimulus to additional work.

Keynote speakers:

1) Gareth Grier (Clinical Director and Education Lead at The Institute of Pre-Hospital Care at London’s Air Ambulance)
"Human factors is as
important as the medicine"
Gareth gave a very interesting talk on pre-hospital care, the golden hour, the training that the air ambulance medics get and the importance of teamwork. Gareth also talked about the adoption of a safety culture and his belief that pre-hospital anaesthesia has to be at least as safe as that performed in-hospital; for example nobody now draws up drugs at the scene. He contrasted the latter with the approach still taken in hospital resus rooms across the country where ampoules and syringes litter the area.

Gareth also discussed how important it is to acquire automatic skills (e.g. intubation, cannulation) so that the cognitive bandwidth which has been freed up by this can be used for other tasks (e.g. situational awareness(SA)). A useful tip was the use of the CRM terms "Eyes in/eyes out" to emphasise the loss of SA of the operator in a technical procedure. The operator would say "eyes in" to make others aware that they need to be "eyes out" to keep an eye on the scene, the patient's vital signs etc. Another useful tip was the use of a "rescue phrase" for the team. This can be used instead of telling people out loud that they are making a grievous error. It is used infrequently but when it is used the receiver pays attention to it.

Lastly Gareth talked about simulation and the need for fidelity. For example, participants should see the smoke, smell the burning and be rained on (with a hosepipe) to create the stressors that they will encounter on the scene.

2) Bill McGaghie (Adjunct Professor in Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, Illinois)
"Self-assessments are biased
and show little relation
to actual performance"
As Jerry Morse, the chair of the SCSN said, Bill McGaghie needs no introduction. His review on simulation-based medical education research, the BEME systematic review on features of simulation that lead to effective learning and his meta-analysis of simulation versus traditional learning are landmarks in the field.

Bill talked about mastery learning and the papers that have shown how a mastery learning programme (in central venous catheter insertion) can lead to T1 (educational outcome in sim lab), T2 (improved patient care practices), T3 (improved patient outcomes) and T4 (collateral effects (e.g. length of stay, cost, improved baseline)) outcomes. Bill encouraged the audience to find the right intervention and then obtain robust data. As these types of studies build up, the evidence-base behind the cost-effectiveness of simulation will grow. This, in turn, will make applying for funding easier.

Bill also showed how the authors of the papers he co-authored has changed over the years. He emphasised that the best research programmes have the following 10 attributes:

  1. Shared goals
  2. Functional diversity
  3. Clear leadership (this may change or rotate)
  4. Shared mental models and language
  5. High standards, recognition and credit
  6. Sustained hard work and commitment
  7. Physical proximity
  8. Minimisation of status differences within the team
  9. Maximisation of the status of the team
  10. Shared activities that breed trust
Bill also talked about where he thinks research opportunities lie and challenges to the health professions. I would recommend attending a conference just to hear Bill speak.

3) Brendan McCormack (Professor and Head of Division, Nursing, Queen Margaret University, Edinburgh)
"Patients deserve much
more than not to be
harmed by healthcare staff"
Brendan talked about person-centred (as opposed to patient-centred care) and patient safety. Brendan asked us to consider why PDSA cycles are so popular and how they often do not change or challenge the underlying values, beliefs and assumptions which cause the resulting structures and processes that we want to change. In effect we are making superficial changes without addressing underlying patterns.

In a very powerful talk (which I am doing a poor effort to convey) Brendan called for a change in the current culture, quoting Buckminster Fuller: 
"You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete."


I attended two workshops, one led by Bill McGaghie on devising your own mastery learning programme and the other led by Jenny Buckland from Amputees in Action. Although very different both were excellent, hands-on and what you would want from a workshop (as opposed to a lecture.)


A major challenge of this conference (and many other simulation conferences) is the difficulty in moving beyond the T1 outcomes in research. The majority of posters and presentations dealing with outcomes still report how the participants felt better about themselves, with no long-term follow-up or evidence of translation into practice. I would love to see more work in this area and more sponsorship of this research.


There it is!
A great conference (even though I missed the Ceilidh) which I would recommend to anybody interested in SBME. The SCSN-ASPiH symposium is becoming a very nice fore-runner for the yearly ASPiH conference.

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