a paediatric scenario in on call physiotherapy simulation ...• imperial college london(2010). the...

AndoverWarMemorialHospitalBasingstokeandNorthHampshireHospitalRoyalHampshireCountyHospital

APaediatricscenarioinoncallphysiotherapysimulationtrainingcanimproveselfreportedcompetency

LockK.,ClarkeH.,BurrellF.,BerryM.


Background

• Qualifiedphysiotherapistsareexpectedtoparticipateinrespiratoryoncallservicesevenifrespiratoryisnottheirchosenspeciality.

• Respiratoryoncallservicesareforacutelyunwellanddeterioratingrespiratorypatientsthroughoutthehospitalsetting,includingpaediatrics.

• Physiotherapistsareresponsibleformaintainingtheircompetencyandundertakinganytrainingtheyrequire.


Simulationbasededucation

WhatisSBE?• Createsguidedexperiences

thatmimicreal-worldprocessesorconditionstoachieveeducationalgoals

• DOH(2011)recommendedsimulationbasededucationasatooltoenhancethegrowthanddevelopmentofallstaff

Keystoachievinggoals• Authenticity• Realism• Design&implementation• Debriefing• Evaluation


EducationalAim1. Facilitateessentialon-callcompetencies

2. Improveclinicalreasoningskills3.Improvepatientsafety

AllOn-callPhysiotherapistsatHHFT

CompetencydrivenSimulation-basededucation(SBE)

approach

ACPRC CSPLocalservice

needsSimulatedPatients Debriefing

Berry et al 2016


EducationalAim

• Berryetal2016concludedthatsimulationbasedtrainingisassociatedwithimprovedclinicalreasoningandselfreportedcompetencyintheabilityofphysiotherapiststomanageadultoncallsituations.

• Theyalsonotedthatitwouldbebeneficialtoincludeapaediatricscenario.

• AsaresultitwasdecidedthatallfutureannualphysiotherapysimulationtrainingatHHFTwouldincludeadultandpaediatricscenarios,aswellascompetencyevaluation


Method

• Physiotherapistsattendedamandatorydayofrespiratoryoncallsimulationbasedtraining.

• Groupsof5-6therapistsattendedeachsession• 2adultand1paediatricscenarios• TheAssociationofCharteredPhysiotherapistsin

RespiratoryCare(ACPRC)oncallcompetencyquestionnaireandSatisfactionwithSimulationExperienceScale(SSES)werecompletedpreandposttraining


SimulationTraining- Thepaediatricscenario

It’s22:00hrsonaFridayeveningTheSpRonG2wardcallsyoutorequestanassessmentofChristopherCurtis,whowasadmitted7daysagowithRSV+bronchiolitis.Overthepastfewhoursthepatienthasdeteriorated.Hehasdevelopedsignsofrespiratorydistress, anewchestx-rayshowsrightsidedwhiteout.TheregistrarfeelsthepatienthasdevelopedpneumoniaandhascommencedIVcefuroximeandisconcernedthepatientisatriskoffurtherdeterioration.


Thepaediatricscenario• Telephonecallplacedto

physiotherapist• Physiotherapistattendedtothe

patient• Xray/obschart/medical

notes/nurse/equipmentavailable• RealtimealterationstoSIM

baby’sobservationsdependingontreatmenttechniqueused

• SHARPDebriefsession• Trainingneedsmetarisingfrom

debrief


Debriefaninteractivediscussionorconversationtoreflectonperformance

Why?

• Criticalpartofexperientiallearning

• Experienceistransformedintoknowledgebyreflection

• Evidencethatwithoutdebriefing,learningorchangedoesnotoccur(McGaghieetal,2010)

SHARPTool

A5steptoolwhichallowsdebriefinginatimelimitedsetting1. Setlearningobjectives2. Howdiditgo?3. Addressconcerns4. Reviewlearningpoints5. Planahead


Results

• AllposttrainingACPRCquestionnairescoreshadimproved

• NonparametricWilcoxonmatched-pairssignedranktestusedtoanalysedata

• 5outof10questionsshowedanimprovementwithasignificantpvalue

• SSESshowedhighsatisfactionwithSBE


Results:ACPRCquestionnaire

Ifeelabletoperformasafeandeffectiveassessmentandtreatmentforbabiesorchildren

Pvalue

Followingcardiothoracic surgery 0.0938

Onventilators 0.1875

Withchronicrespiratorydisease 0.0352

Withacutemedicaldisease 0.0001

Withmultipletrauma 0.0156

Withunstablespine 0.1563

Withraisedheadtrauma/raisedICP 0.0313

Whoareunstable 0.0078

Withtracheostomy 0.2188

In‘endoflife’situations 0.1250


IfeelabletoperformasafeandeffectiveassessmentandtreatmentforbabiesorchildrenwithacutemedicaldiseasePvalue0.0001


ParticipantcommentsClinicalexperiencewithrealpatients

Paeds,paeds,paeds(thoughI’mokwhenI’mthere)

Increasedunderstandingofpaedsnormalobservations Moreacuterespiratory

paedsexperiencewithpaedsstaff

Arrangewithpaediatricspractical

experience

Beexposedtomorecomplexscenariosinthepaediatric

settingLearningNeeds


SSESResults

%


Discussionpoints

• SIMtrainingimprovedphysiotherapistsselfreportedcompetencewithpaediatricpatientsspecificallythosewithacutemedicaldisease.

• Thechoiceofscenarioisimportant.• Vitaltochoosescenariosthatarelikelytopresenton

HHFTpaediatricwards.• HighsatisfactionlevelswithSBEoncallphysiotherapy

training.• SBEeducationallowsexposuretosituationsthatmayarise

whilstoncall,allowingmentalrehearsalandnormalisation.


MovingForward

• Recentlystartedcycle2ofannualoncallSIMtrainingwithapaediatricscenario

• NewpaediatricscenariobasedonarealpatientcasefromHHFT

• MyrolecontinuestoinvolvedevelopingscenariosandfacilitatingSBEsessions

• ?Potentialforcreatingincome• ?DevelopSBEforpaediatricphysiotherapists


AnyQuestions?


References• ImperialCollegeLondon(2010).TheLondonHandbookforDebriefing:Enhancingperformance

debriefinginclinicalandsimulatedsettings.• MBerry,FBurrell,RLChapman,SGough,SEwings,DThackray(2016).Simulation-based

trainingcanimproveon-callphysiotherapists’clinicalreasoningabilitiesandself-reportedcompetency.Physiotherapy102,e269-e270

• McGaghieWC,IssenbergSB,PetrusaER,ScaleseRJ.Acriticalreviewofsimulation-basedmedicaleducationresearch:2003-2009.MedicalEducation,2010Jan;44(1):50-63.

• DepartmentofHealth(2011).AFrameworkforTechnologyEnhancedLearning• Levett-JonesT1,McCoyM,LapkinS,NobleD,HoffmanK,DempseyJ,ArthurC,RocheJ.The

developmentandpsychometrictestingoftheSatisfactionwithSimulationExperienceScale.NurseEducationToday.2011Oct;31(7):705-10.doi:10.1016/j.nedt.2011.01.004.Epub2011Feb2.

• SandyThomas,SuzanneGough,Mary-AnnBroad,JaneCross,BeverleyHarden,PaulRitson,Matthew.On-callcompetence:developingatoolforself-assessment.Physiotherapy-September2008(Vol.94,Issue3,Pages204-211,DOI:10.1016/j.physio.2008.02.006)

a paediatric scenario in on call physiotherapy simulation ...• imperial college london(2010). the...

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