Proceedings of the

4th Research and Development Conference

Clinical Skills Managed Education Network

17th March 2017

Executive Summary This is a summary record of proceedings from the 4th Research and Development Conference which was organised by the Clinical Skills Managed Education Network held in Stirling. Over 65 delegates attended from throughout NHS Scotland. Plenaries, short communications, posters and small group work identified a robust platform on which to build a more integrated collaborative strategy for research in simulation based education. This will include initially setting up a research interest group within the Safety, Skills and Improvement Executive Education Board.

Background to the 4th Conference on Research and Development This conference delivered part of the overall aims of the CS MEN to provide simulation based education to health care practitioners in NHS Scotland, irrespective of professional background or geographical location in keeping with the core principles of a managed educational network outlined below:

• Functioning with explicit management arrangements• Embedding systems of accountability • Agreeing expected outcomes• Utilising an evidence base• Committing to Research and Development • Having a multi-professional and multidisciplinary staff engagement focus • Engaging in a system of dissemination• Generating better value for money

adapted from MCN NHS HDL 69 (2002)

Over the past eight years CS MEN has been responsible for developing evidence based on-line clinical skills resources, workshops, train the trainer courses and skills training on the mobile skills unit as well as working collaboratively to research simulation and develop skills practice and simulation based educators. This will ensure the workforce have access to the same standards throughout Scotland.

Programme of 4th Research and Development Conference The conference was held in Stirling on the 17th March 2017 and the programme was as follows:

10.00 Welcome and OverviewJean Ker Clinical Lead, CS MEN, Paul Bowie, Programme Director, Safety and Improvement and Laura Allison, Head of Quality Improvement

10.15 IntroductionThe past – A summary of CS MEN funded projects and their outcomes

10.30 Plenary SessionsThe present – Simulation based education: understanding the social - cultural complexity of a surgical boot camp - Plenary by Jen Cleland, AMEE prize winner Collaboration on over the counter pharmacy skills – Anne Watson and Fiona Reid, RPS prize-winners

11.30 Coffee11.45 Short Communications (15 minutes)

The present – in situ paediatrics, building the evidence - Linda Clerihew Previous Scottish patient safety fellow

Using a realist approach to evaluate the MSU - Susan Somerville, PhD Student Implementing the SBE outcome framework – some case studies - Catie Paton, Clinical Skills Lead,

Medical Education and Training Centre The impact of tele-education - Colville Laird, BASICS Director

13.00 Lunch

13.45 Poster viewing see “Present” section for list.14.15 Future research & development priorities by Jean Ker

The purpose of this session is to receive input from delegates to identify and agree future priorities for multi-professional simulation based research

15.00 Feedback and Panel DiscussionThe future – identifying priority areas for research and developmentPanel: Jerry Morse, Pam Nicol, Paul Bowie, Peter Johnston, Colville Laird, Michael Moneypenny, Julie Mardon, Anna O’Neill, Ken Walker

15.30 Summing-up of key priorities of research and development for the use of simulation through increased collaboration, Derek Bell – President, Royal College of Physicians, Edinburgh

Delegates The conference was over-subscribed highlighting the increasing interest in evidencing not whether simulation based education works, but exploring what works best for whom, where and with what modality.

Over 65 delegates represented most of the territorial health boards including Tayside, Greater Glasgow and Clyde, Grampian, Forth Valley, Lanarkshire, Dumfries and Galloway, Ayrshire and Arran, Highland and Lothian. There was representation from NHS Education for Scotland. Professional groups present included medical, nursing, allied health professions, psychologists and dentists.

Organisations linked to simulation based education such as IHSE Dundee, the Scottish Simulation and Human Factors Centre at Larbert, the SCSN, RRHEAL and BASICS also attended. Universities were also represented including Robert Gordon, Dundee, Edinburgh, Glasgow, Aberdeen and Napier.

The 4th conference was titled the Past Present and Future of simulation based education research and development with the aim of reviewing what had been achieved, what was currently being undertaken and then to use the expertise of the delegates to explore the future direction of simulation based education research and development.

The Past of CSMEN Simulation Based Education Research and Development This was the fourth Research and Development conference organised by the CS MEN team. The first had focused on improving quality of medical education research, the second on advances in simulation based research and the third on the impact of human factors science on simulation based education research. Over the past eight years 26 projects have received seed corn funding from the CS MEN R and D fund and there are currently 18 completed reports on the CS MEN website. Six peer reviewed publications have resulted from the projects and three of the awards have funded MDs and three have funded Masters projects. A list of the projects funded is available on the website. One paper won the best simulation paper at the international AMEE conference. One of the development projects has expanded to national scale and won a UK Royal Pharmaceutical Society Award.

The present of CS MEN Simulation Based Education Research and Development In relation to clinical skills research and development using simulation the conference heard from a selection of projects to highlight both the breadth and depth of the current profile in Scotland. In addition, several projects were discussed during the poster session. Jen Cleland shared the award-winning findings from the NHS Education for Scotland surgical boot camp in relation to understanding socio-cultural complexity, ably demonstrating how important it is

to undertake a pilot before determining your research question and how important the underlying educational theory can be in answering your question.

Anne Watson and Fiona Reid from Pharmacy then shared their award-winning development in relation to workforce development of pharmacy staff using simulation to enhance and set standards of skills practice for their national programme. Opportunities for research were then discussed with delegates in an open forum.

Four short presentations highlighted several areas of research and development:

Linda Clerihew on how in situ simulation had been used to improve preventable harm in paediatrics built around six clinical scenarios.

Susan Somerville shared using a realist evaluation theoretical approach to explore the impact of the MSU.

Catie Paton demonstrated how she had applied the Scottish simulation based educator framework to her faculty development programme.

Colville Laird shared BASICS users experience in using tele-education for learning and maintaining skills.

There were also a number of submitted posters at the conference which were judged by two of the regional champions Anna O’Neill and Jerry Morse.

Poster Authors Poster TitleColl, R; Paterson, R; Rolfe, A; Kinnear, M

A novel simulation prescribing masterclass for medical and non-medical prescribers

Hamilton, A; Kerins, J; Tallentire, V; Maccrossan, M

The Development of a Behavioural Marker System to Assess the Non-Technical Skills of Medical Students in Acute Care – The Medi-StuNTS System

Mardon, J Delirium in the ED – In Situ Simulation Creates Real Quality Improvement

Mills, P; McLenaghan, L; Gordon, J; Mardon, J

Intranasal diamorphine: a pain in the nostrils? Simulation use to aid clinical practice

Winter, G Paediatric Simulation in AberdeenMilner T.D; Okhovat, S.; Kubba, H.; Levine, R.; Clement, WA.; Kunanandam, T. Wynne, D.M

Using simulation to enhance ENT hospital induction

Okhovat, S.; Milner T.D.; Kubba, H.; Levine, R.; Clement, WA.; Kunanandam, T. Wynne, D.M

Paediatric airway reconstruction surgery: optimising training through simulation

O’Reilly, M; Smart, A; Barrett, N Dementia Awareness - ‘Getting into the shoes of the individual’Stallard, M; Moneypenny, M Assessing trainee confidence and identifying barriers in procedural

skills performanceFraser, F Collaboration and shared understanding: Case Studies

demonstrating Quality Assurance approaches within Distributed Education, aiding access, inclusion and educational economy.

Jones, A; Fraser, F; MacRury, S; Thain, A

Video conferencing applications to establish a distributed educational network: enhancing early referral of those with acute diabetic foot

Nicoll, P Developing a Technology Enabled Workforce

The Future of Simulation Based Education Research and Development

In this session delegates were introduced to the future of simulation based education research by the clinical lead of the CS MEN Jean Ker who identified the relevant literature in terms of the priorities for medical education research in Scotland to recognise the current influences in setting the direction. She highlighted Denis’ paper on exploring stakeholder views of medical education research priorities from 2014 and McGaghie’s paper in 2010 on a critical review of simulation based education research 2003-2009 as useful starting points. She also drew delegates attention to the Safety, Skills and Improvement Board in NHS Education in Scotland which presented opportunities for collaborative working having heard briefly from, Laura Allison the Quality Improvement lead and Paul Bowie, the Safety and Improvement lead. Links to the Scottish Medical Education Research Consortium were also highlighted.

This set the scene for delegates to work in 8 interprofessional groups to suggest 3 research priorities and identify questions related to their priorities for the panel. Research priorities identified included:

Preparing graduates for the reality of practice (medicine) Using simulation to test system thinking and working The role of simulation in quality improvement Simulation’s role in staff resilience What is the impact of not doing simulation based education? The use of simulation in improving wellbeing and performance Peer to peer feedback in debriefing Obstacles and opportunities of embedding in situ SBE into workplace Establish what we mean by ‘a safe learning environment’ in simulation - safe for whom? Developing robust metrics to assess impact of SBE Using QI methods to test simulation based education Explore what educational gaps SBE is addressing

The priorities, issues and questions generated for each group can be found on the website.

A panel of experts in simulation based education and research (Jerry Morse, Pam Nicol, Paul Bowie, Peter Johnston, Colville Laird, Michael Moneypenny, Julie Mardon, Anna O’Neill and Ken Walker) then answered some challenging questions from delegates related to use of simulation for assessment, linking simulation based education to patient outcomes and the use of simulation in revalidation. Pockets of excellence in SBE research was acknowledged but the need for pace and spread of the use of SBE was explored by panel members.

Derek Bell, President of the Royal College of Physicians of Edinburgh summed up the day’s proceedings. He identified that Scotland was a leader in clinical skills and recognised the need to provide an evidence base around SBE impact not only on learners but on patients. Simulation based education given it is a complex intervention will therefore require a multidisciplinary and collaborative approach to research. He called for a national research strategy in simulation based education pointing out the need for research to ensure we continue to deliver a vibrant and quality health service. He also highlighted the need for innovation as part of the future for research, given the advances in technology.

Presentations were made to the poster winner and to the regional champions who had worked for CS MEN for eight years. This conference generated not only suggested priority areas but an energy level in terms of enthusiasm to taking the agenda forward in relation to working together in developing an evidence base and exploring learning in the context of simulation based education.