Month: June 2013

Multiprofessional Simulation training in the Emergency Department

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IMG_2053We recently set up a temporary simulation area adjacent to the emergency department for use by undergraduate, postgraduate and nursing teams.

This is the first time that we have been able to deliver multi-disciplinary, multi-professional training on site for surgical and medical emergency teams. This is a key development in patient safety for the trust and will lead to better care for patients and in particular for the multi-team working required in our role as a trauma centre.

IMG_2054The simulator is a SimMan3G essentials with a range of accessories to simulate traumatic and medical conditions. The set up includes recording equipment for sound and video feedback (rather embarrassing when you first use it, but you get used to it), in a space that recreates the resuscitation bay in the ED.

Daily simulations (almost we’re not yet there at the weekendsūüėČ ) are now taking place with members of the nursing and medical teams learning together about clinical care, human factors and patient safety.

Why simulate?

In a hospital as busy as MRI you might think that we don’t need to simulate that much as we have so many ‘real’ cases all the time. That’s not the point though. There are many reasons why simulation is a great learning tool, but I’ll pick four of the big ones.

1. We can simulate once in a lifetime emergency events. That’s once in a lifetime for the clinicians rather than the patients. When I became a consultant I had never seen an emergency surgical airway performed in the ED. I had practiced the technique on a sheep’s larynx but had never integrated this into the whole patient scenario and clinical decision making process. With SimMan we can do this over and over again so that when future clinicians face the really scary decisions they have at least practiced it in the SimLab first.

2. We use Sim to look not just at knowledge, but at how teams work and communicate together. Medical error is often related to how teams work together, communicate and lead. The famous Elaine Bromley case is a great example of what happens when things go wrong. In the SimLab we video, record and feedback to clinicians about how they work together in a team. We look for good practice and offer solutions in areas where improvements are needed.

Just A Routine Operation from thinkpublic on Vimeo.

3. Time……In the resus room and in any emergency patient care never stops and it’s very difficult to debrief, reflect and learn. In SimLab we can do this with audiovisual support. A 10 minute scenario can be played back, stopped, discussed and shared with participants. It’s a fantastic way to learn and develop safe patient strategies.

4. Not everything in hospitals goes perfectly all the time and we are constantly striving for improvements. Let’s take trauma for example. We are tasked with getting our major trauma patients to the CT scanner within 30 minutes of arrival. This is a tough task which requires us to be really slick at patient assessment, movement, handling, communication etc. We can learn from reflecting back on real patients – but then we can put that learning into action by simulating the same patients in the resus room to try out different techniques with the mannequin (rather than with the next real patient!!).

In other words this is a fantastic development for the trust supported by monies made available by the medical director, and the enthusiasm and hard work of the ED team. The management team in ED have been fantastic, Jason, Dal, Nathanial, Jonathan and others – stars all of them. I must also thank Medical Engineering for helping us stock up with decommissioned equipment and Nick Smith in undergrad who has been amazingly helpful in teaching us how to get the best out of Sim.

Unfortunately SimLab itself will soon be converted to offices but don’t worry, this is not the end. Simulation is not restricted to a particular space or time……..

We are going to move to Guerrilla Sim!

The mannequin runs it’s own wifi network and is completely portable so we can take it anywhere, anytime and with anybody…. Guerrilla Sim is when the simulation comes to you, rather than you coming to SimLab.

We can wheel it to any space in the ED (well anywhere in the hospital to be honest) in a matter of minutes and run a scenario in real time. Arguably we might just end up with more realism this way.

Watch this space for more information and if you are on a crash/trauma/resus team just be aware that the next call might involve lights, camera and hopefully a bit of action.

AoMRC and NHS Employers on ensuring safe induction

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August from: Très Riches Heures du duc de Berry. Wikipedia Commons
August from: Très Riches Heures du duc de Berry.
Wikipedia Commons

Summer has (sort of) arrived in Manchester. The pattern of work has changed in some departments (Paeds ED is all trauma rather than the winter D&V) and most of our staff are settled into their roles. August will soon be upon us, and in postgrad that means that minds are turning towards induction.

There is a great deal of work to do to ensure that new starters are safe to practice. In foundation training we have the luxury of a 2 week shadowing period to bring our new starters up to speed, but at other grades there are frequently difficulties in balancing the need to complete all aspects of induction alongside delivering an effective and safe service. As a supervisor I often feel the paradox of needing to ensure that the department is staffed (for patient safety reasons) whilst also inducting the new docs (for patient safety reasons). Whilst this will remain a challenge, (particularly in the acute specialities), a new document from NHS Employers and the Academy of Medical Royal Colleges places an emphasis on the delivery of training to ensure our junior docs are safe.

You can download the guidance here. safe-trainee-changeover, but in summary the document identifies 4 themes to facilitate trainee changeover.

  • 1. Consultants must be appropriately available
  • 2. Flexible and intelligent rota design
  • 3. High quality clinical induction at all units
  • 4. Reduction of elective work at changeover times

To some extent this is stating the obvious. However, the suggested mechanisms for rota changes are perhaps interesting enough to deserve a read. The implication of not putting trainees on out of hours rotas when they first start will be a challenge to many and indeed impossible for some. In that case we must look to new and innovative ways to deliver induction content (such as e-learning packages).

I was also interested to see that work is being done to stagger changeover for trainees to avoid the ‘all change at once’ situation currently faced by some specialities. This would in my opinion be a great step forward and with a report from¬†AoMRC/CoPMeD due any day we should be looking out for this soon.

So, as the Summer wanes (as far as I can make out it started and ended last week) it is time to think about how we deliver induction this year. June is a great month to dust off last years plans and to ask ourselves whether they are still fit for purpose, but if you did not manage it then, July will do just fine.



GMC Trainee’s survey published

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GMC-1The GMC has released the results of the trainee survey for 2013. This has a huge amount of data on the training posts within the trust and it’s essential reading for all of us involved in postgraduate education.

All the GMC results are available online and as public access. You can access the database at the following address….

The online reporting tool allows you to look at the data in several different ways. The postgrad team will be looking into this in some detail over the next few weeks. We’ve already seen some really interesting data with some really great feedback, and also some areas that will require further investigation.

From a personal point of view I’d like to draw attention to a great report on the overall satisfaction score for Emergency Medicine Training at CMFT. The department received the second highest score in the country for overall satisfaction with only Sheffield Children’s Hospital (a specialist paediatric unit) scoring higher.

There are many other great messages in the survey so if you are a trainee, trainer or if you are interested in joining us please use the data that the GMC have provided.

What can the medical reg be expected to do? CMFTPostgrad

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I’ve seen an interesting document today from the Royal College of Physicians about what we can and perhaps cannot expect of the medical registrar when on call in acute hospitals. The main document can be found here….

Governance Statement regarding patient safety issues in relation to practical procedures carried out by trainee doctors in physicianly specialties Рupdated statement May 2013

Firstly, I love the concept of ‘physicianly’ specialities, it’s clearly an underused word and I think we should hear it more.

Secondly, there is some important information here about what we can expect middle grade physicians to be able to do in terms of practical skills. This perhaps reflects a changing training program and a greater oversight of assessment of competence to increase patient safety which is no bad thing.

Here at CMFT we have a number of strategies to ensure that doctors are fit for their role including the use of simulators for procedures such as chest drains. In addition there is excellent support from the critical care and anesthetic teams for some of the procedures on the list such as central venous catheterisation.