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The use of distance learning technologies to bring simulation-based critical care training to a remote community in northern Canada
Timothy Willett, RCPSC; Susan Brien, RCPSC; Pierre Cardinal, RCPSC & uOttawa; Rick Hodder, uOttawa; John Kim, uOttawa; Dave Neilipovitz, uOttawa; Shahin Shirzad, UBC.
2011 MedBiq Conference, 11 May 2011
Critical care
•Patients with an imminently life-threatening condition
•Time is tissue
•Community:• Critical illness can happen anywhere• Community practitioners recognition & early
intervention
•Training:• Simulation-based• ABCs, crisis resource management
2
Iqaluit (formerly Frobisher Bay)
•~3000 km from tertiary care
•Population 6,200
•Only hospital in Nunavut (population 30,000)
•Nunavut > 2,100,000 sq km 15th in world!
4
Challenges
•Health human resources
•Transport
•Access to CPD
•Cost (either way)
•Goal: Test a distance-learning model of a simulation-based critical care course (ACES)
5
Methods
Funding:• Health Canada• RBC Foundation• Royal College
1) Needs assessment• Context• Priority needs• Learners
2) Modify course
6
Methods
3) Delivery• Web modules• Lectures• Case discussions• Task training• Simulation
4) Evaluation• Questionnaires• Pre- and post-course quiz• Post-course simulation (on-site)• Delayed interviews
7
TeleMedicine
Results: Sessions
•4 web modules• poorly used• access issues• well-liked
•TeleMedicine: 8 sessions• 4 hrs lecture & cases• 3.5 hrs task training• 4 hrs SimuCase VP
9
“In terms of the [TeleMedicine], the mannequins, that kind of thing and
doing this all kind of on a long distance basis, I think it was
effective.”
Results: Questionnaire
10
Relevant
Videoconference effective
Technical skills improved
Confidence increased
Will not change practice
SimuCase allowed practice
SimuCase feedback useful
Results: Quiz
•28% improvement
•Paired t-test (n=10): p=.016
•Cronbach’s alpha: 0.67
11
Group n Mean score (/20)
Iqaluit (pre) 15 9.5
Iqaluit (post) 10 12.5
Junior ICU residents 5 7.7
Senior ICU residents 6 13.6
Results: High-fidelity simulations
•2 cases
•10 physician candidates: 1 leader, 1 assistant
•RN actor
•2 facilitators from Ottawa
•Videotaped
•Checklist: Custom, Delphi process
•GRS: “Ottawa GRS”
•Standard: Modified Angoff
12
Results: High-fidelity simulations
13
Measure Case 1 (GI bleed) Case 2 (Sepsis)
Expected score
Mean candidate
score
% met or exceeded expected
Expected score
Mean candidate
score
% met or exceeded expected
Checklist score 19.0 24.6 90 20.1 26.7 100
Ottawa GRS: Overall performance score
4.2 5.3 70 4.2 5.7 100
• Leadership skills 4.5 5.6 60 4.5 6.1 90
• Problem-solving skills 3.8 5.4 90 3.8 5.6 100
• Situational awareness skills
4.3 5.1 70 4.0 5.6 100
• Resource utilization skills 4.0 5.6 100 4.0 5.9 100
• Communication skills 4.8 6.1 90 4.8 6.2 90
Results: Delayed interview (prevalent themes)
• Positive experience, appreciative
•Well qualified instructors
• Technical problems not significant
• Changes in:
• Approach to critically ill patient / priorities• Vasoactive medications• Assessment / monitoring• Confidence• Communication
•Delivery strategy was effective; liked the on-site simulations
• SimuCase was effective; enhanced skills applicable to high-fidelity simulation
14
Lessons learned
•Support from decision-makers
•Community-based coordinator
•TeleMedicine tech support
•Web modules: disc backups
•Virtual patient works
•Outcomes positive
•Limitations:• Pilot study, small n, limited rigour
15
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