nhs lothian clinical skills mastery programme
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NHS Lothian Clinical Skills Mastery Programme. James Tiernan June 2014. Implementing safe and effective clinical performance. Postgraduate Clinical Procedural Skills. Is there a problem?. Learning and teaching skills is a challenge. One Approach: The skills carousel. - PowerPoint PPT PresentationTRANSCRIPT
Quality Education for a Healthier Scotland
NHS Lothian Clinical Skills Mastery Programme
James TiernanJune 2014
Implementing safe and effective clinical performance
Quality Education for a Healthier Scotland
Postgraduate Clinical Procedural Skills
Is there a problem?
Quality Education for a Healthier Scotland
Learning and teaching skills is a challenge
Quality Education for a Healthier Scotland
One Approach:
The skills carousel
Quality Education for a Healthier Scotland
An alternative approach:
Lothian Clinical Skills Mastery Programme
• Why? Many trainees are not achieving procedural competencies
• How? A skilled team to facilitate learning via safe, simulated practice.
• What? The Mastery Programme
Quality Education for a Healthier Scotland
Knowledge
Skills
Drills
Performance
Safety
Quality Education for a Healthier Scotland
Intended Learning Outcomes
TraineesAfter participation in the mastery programme, the doctor in training will have the skills required to achieve competency in mandatory and desired procedural skills to the level of safe clinical performance under supervision.
TutorsAfter participation in the mastery programme, the faculty clinicians will be able to teach clinical procedural skills to doctors in training in an effective and structured fashion, receiving appropriate recognition for their contributions.
Quality Education for a Healthier Scotland
NHS Lothian Clinical Skills Mastery Programme
Unskilled Doctor
Knowledge + Video Packs
(On line) Task Trainer Lab Sessions
Ongoing Clinical Practice
Competent Doctor
Task Trainer In-Situ Sessions
Supervised + Video
Supervised + Video
Faculty Development + Accreditation
Supervised
Co-ordination via Online Booking System
+
SessionalChecklist
Skills Assessment
Quality Education for a Healthier Scotland
Education Packs
• Reading and Video
• Online– New MED Website
• Checklists– Formative assessment
Quality Education for a Healthier Scotland
TUtorial Booking System “TUBS”
• https://tutorialbooking.com
• Advertise a session
• Sign up to sessions
• Automatic feedback generated
• Teaching Log generated for ARCP
• All of SE Scotland
Quality Education for a Healthier Scotland
Skills Lab Session
• 1 Trainee + 1 tutor
• Discussion of experience and concerns
• Lab environment
• Demonstration
• Practise
• Feedback
• Trouble shooting and discussion
• Establish motor skills + clinical decision making
Quality Education for a Healthier Scotland
Clinical Session (In situ)• 30mins - 1hr
• 1 Trainee + 1 tutor
• PAA / ARU / PAA
• Full Asepsis + Drapes
• Entire procedure under supervision
• Feedback
• Trouble shooting and discussion
• Establish simulated safety and competence
Quality Education for a Healthier Scotland
Faculty Induction and Development
via The Clinical Educator Programme
Quality Education for a Healthier Scotland
Faculty Right Person – Right Skill – Right Way – Right Place – Right Time
• Consultant / Registrar / Specialty Doctors facilitators– ST3+– Anaesthetics / ITU / Medical specialties / A&E
• Skill-specific
• Induction process– Introductory session– Observation– Facilitation (supervised)– Facilitation (unsupervised)
• Accreditation via Clinical Educator Programme– Recognised for ARCP / CPD
Quality Education for a Healthier Scotland
How can we effectively teach procedural skills?
Quality Education for a Healthier Scotland
The Challenge: TRANSFER
Learning for Quality and Safety
Quality Education for a Healthier Scotland
Johari Window
Conscious Competence
Conscious Incompetence
Unconscious Competence
Unconscious Incompetence
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Development
Learning for Quality and Safety
Quality Education for a Healthier Scotland
Break it Down
Bite Size Chunks
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Procedural Phases1. Preparation, Assistance and Positioning
Non technical skills + clinical decision making
2. Asepsis + Anaesthetic
3. Procedural Pause3 Point Check
4. Insertion
5. Anchoring + Dressing
6. CompletionDocumentation / Communication / Trouble shooting
Quality Education for a Healthier Scotland
Non- Technical Skills
These allow effective and timely Escalation of care
Category Element
Situation Awareness:Gathering Information
Pause to interpret information
Projection to future states
Decision Making:Generating Options
Balancing Options
Reviewing of Decisions
Getting the Job Done:
Prioritising (tasks and patients)
Maintaining Standards
Planning and preparing
Utilising Resources
Teamwork:
Speaking up
Establishing shared understanding
Establishing a team
Mellanby et al. 2013
Quality Education for a Healthier Scotland
Evidence Base
Quality Education for a Healthier Scotland
Evidence Base - Outcomes• T1 - Lab measurements
– Thoracocentesis / LP / Paracentesis
• T2 - Patient care practices– CVC / Laparoscopy
• T3 - Patient outcomes– Bacteraemia, ITU admissions, LOS
• T4 – Collateral effects– Cost savings, Other trainees
McGaghie et al. 2014,
Medical Education
Quality Education for a Healthier Scotland
Mastery Programme LP Study Aims – To demonstrate:
• Improved performance of LP via Mastery methodology– Safety– Sterility– Success
• Impact of environment on simulated performance– Added value of in-situ training
Quality Education for a Healthier Scotland
Mastery Programme LP Study
Reading and Video Learning
Lab Skills Session
Lab Skills Session In Situ Skills Session
Assessment In Situ
Follow Up Questionnaire / Interview
Phase 1
Phase 3
Phase 2
Group A Group B
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Progress
• Sessions
• Faculty
• Feedback
• Study outcomes TBA
Quality Education for a Healthier Scotland
Next Steps• Expansion into other trainee groups• Inclusion of other skills
• Faculty expansion– Multi-professional tutors
• Enhancing faculty + time protection
• Evaluation of Clinical Outcomes
• Mastery Model – Mandating simulated competency prior to real life
Straight forward
Challenging
Culture change
Quality Education for a Healthier Scotland
NHS Lothian Clinical Skills Mastery Programme
Unskilled Doctor
Knowledge + Video Packs
(On line) Task Trainer Lab Sessions
Ongoing Clinical Practice
Competent Doctor
Task Trainer In-Situ Sessions
Supervised + Video
Supervised + Video
Faculty Development + Accreditation
Supervised
Co-ordination via Online Booking System
+
SessionalChecklist
Skills Assessment
