Team Training for Interprofessional Insight, Networking and Guidance (T2IPING) points: a study protocol

Effective teamwork remains a crucial component in providing high-quality care to patients in today’s complex healthcare environment. A prevalent ‘us’ versus ‘them’ mentality among professions, however, impedes reliable team function in the clinical setting. More importantly, its corrosive influence extends to health professional students who model the ineffective behaviour as they learn from practicing clinicians. Simulation-based training (SBT) of health professional students in team-based competencies recognized to improve performance could potentially mitigate such negative influences. This quasi-experimental prospective study will evaluate the effectiveness and impact of incorporating a multi-year, health science centre-wide SBT curriculum for interprofessional student teams. It targets health professional students from the Schools of Medicine, Nursing and Allied Health at Louisiana State University (LSU) Health New Orleans. The intervention will teach interprofessional student teams key team-based competencies for highly reliable team behaviour using SBT. The study will use the Kirkpatrick framework to evaluate training effectiveness. Primary outcomes will focus on the impact of the training on immediate improvements in team-based skills and attitudes (Level 2). Secondary outcomes include students’ perception of the SBT (Level 1), its immediate impact on attitudes towards interprofessional education (Level 2) and its impact on team-based attitudes over time (Level 3).The Institutional Review Board at LSU Health New Orleans approved this research as part of an exempt protocol with a waiver of documentation of informed consent due to its educational nature. The research description for participants provides information on the nature of the project, privacy, dissemination of results and opting out of the research.

Team Training for Interprofessional Insight, Networking and Guidance (T2IPING) points: a study protocol

Effective teamwork remains a crucial component in providing high-quality care to patients in today’s complex healthcare environment. A prevalent ‘us’ versus ‘them’ mentality among professions, however, impedes reliable team function in the clinical setting. More importantly, its corrosive influence extends to health professional students who model the ineffective behaviour as they learn from practicing clinicians. Simulation-based training (SBT) of health professional students in team-based competencies recognized to improve performance could potentially mitigate such negative influences. This quasi-experimental prospective study will evaluate the effectiveness and impact of incorporating a multi-year, health science centre-wide SBT curriculum for interprofessional student teams. It targets health professional students from the Schools of Medicine, Nursing and Allied Health at Louisiana State University (LSU) Health New Orleans. The intervention will teach interprofessional student teams key team-based competencies for highly reliable team behaviour using SBT. The study will use the Kirkpatrick framework to evaluate training effectiveness. Primary outcomes will focus on the impact of the training on immediate improvements in team-based skills and attitudes (Level 2). Secondary outcomes include students’ perception of the SBT (Level 1), its immediate impact on attitudes towards interprofessional education (Level 2) and its impact on team-based attitudes over time (Level 3).The Institutional Review Board at LSU Health New Orleans approved this research as part of an exempt protocol with a waiver of documentation of informed consent due to its educational nature. The research description for participants provides information on the nature of the project, privacy, dissemination of results and opting out of the research.

Novel do-it-yourself low-cost abdominal laparoscopy entry simulator for gynaecology trainees

The COVID-19 pandemic has affected gynaecology trainees in the United Kingdom by reducing operating theatre experience. Simulators are widely used for operative laparoscopy but not for practising laparoscopic-entry techniques. We devised a low-cost simulator to help trainees achieve the skill. Our aim was to pilot this low-cost simulator to perform Royal College of Obstetricians and Gynaecologists (RCOG) supervised learning events.A single-centre pilot study involving six gynaecology trainees in a structured training session. Interactive PowerPoint teaching was followed by trainees’ demonstration of laparoscopic entry for a supervised learning event and personalized feedback. Participants completed pre- and post-course questionnaires.All the trainees found the training useful to the score of 10 (scale of 1–10) and recommended this to be included in Deanery teaching. Personalized feedback was described as the most useful. The simulator was rated as good as a real-life patient relative to the skill being taught.Gynaecology trainees are affected by lack of hands-on experience in the operating theatre for performing laparoscopic entry. A low-cost abdominal laparoscopy entry simulator can help deliver the RCOG curriculum, enabling trainees to achieve required competencies.

125 INTRODUCING AN IN SITU SIMULATION PROGRAMME IN AN INTENSIVE CARE UNIT

This North London hospital has a 14-bed Intensive Care Unit (ICU). As a small District General ICU, staff exposure to emergency scenarios can be infrequent. Lack of practice can lead to a reduction in staff confidence and knowledge when these scenarios are encountered, especially during the COVID pandemic. The ICU had not previously undertaken in situ multi-disciplinary team (MDT) simulation sessions on the unit.The aim of the study was to introduce a novel programme of MDT simulation sessions in the ICU and provide feedback with the aim of increasing both staff confidence in managing emergency scenarios and staff understanding of the impact of human factors.A team of ICU Simulation Champions created emergency scenarios that could occur in the ICU. Pre-simulation and post-simulation questionnaires were produced to capture staff opinion on topics including benefits and barriers to simulation training and confidence in managing ICU emergencies. Members of the ICU MDT would be selected to participate in simulation scenarios. Afterwards, debrief sessions would be facilitated by Simulation Champions and Airline Pilots with a particular focus on competence in managing the emergency and human factors elements, such as communication and leadership. Participants would then be surveyed with the post-simulation questionnaire.Nine simulation sessions were conducted between October 2020 and June 2021. The sessions occurred within the ICU during the working day in a designated bay with the availability of all standard ICU resources and involved multiple MDT members to aid fidelity. Feedback by Simulation Champions mainly focussed on knowledge related to the ICU emergency, whilst the Airline Pilots provided expert feedback on human factors training. Fifty-five staff members completed the pre-simulation questionnaire and 37 simulation participants completed the post-simulation questionnaire. Prior to simulation participation, 28.3% of respondents agreed they felt confident managing emergency scenarios on ICU – this figure increased to 54.1% following simulation participation. 94.4% of simulation participants agreed that their knowledge of human factors had improved following the simulation and 100% of participants wanted further simulation teaching. Figure 1 shows a thematic analysis of the responses from 31 participants who were questioned about perceived benefits from simulation teaching. Following the success of the programme, the Hospital Trust will continue to support and develop inter-speciality and inter-professional training, and have funded the appointment of an ICU Simulation Fellow to continue to lead and enhance future in situ simulation teaching on the ICU.

193 BALANCING EDUCATION AND PRACTICE: A REFLECTION FROM A SIMULATION EDUCATOR DURING THE COVID-19 PANDEMIC

What? I consider myself privileged to divide my work time between my roles as a clinical simulation educator and as an intensive care nurse in a large teaching hospital. I find that working alternate weeks in educational and clinical roles can be challenging because both demand complementary but different skills. However, I am thrilled to have the opportunity to continue caring for patients alongside supporting and learning with colleagues. Balancing these roles during a pandemic presented me with new challenges and rewards, and reflection on these experiences has given me some fascinating insights. As the COVID-19 pandemic progressed and the number of patients requiring admission to the Critical Care Unit increased, the units were expanded and staff were redeployed from other areas to provide support. These ‘surge’ staff required rapidly developed simulation-based training to allow them to work in this unfamiliar environment within a restricted scope of practice. Being involved with delivering this training as well as working with surge staff in Critical Care afforded me a deeper understanding of the surge role and the unique challenges it presented. Once surge training was completed and I returned to delivering our standard simulation-based education courses, my experiences of working clinically continued to enrich my teaching because I felt somewhat familiar with some of the challenges our learners were facing as the pandemic continued. So what? Over the last year, I have felt conflicted at times; when working clinically during the peak of the pandemic, there was very little time to facilitate learning at the bedside, and during my educator weeks I relished the opportunity to support and teach but felt guilty for spending time away from colleagues and patients in Critical Care Unit. However, continuing with both roles better equipped me to answer questions and to provide support during surge training, particularly for those staff who had not yet spent time on the units. When assisting with other courses as a faculty member, I was able to deeply empathize with participants who encountered situations that I had become familiar with in practice – for example, communicating with others when wearing full personal protective equipment – which helped me to validate and normalize some of the experiences shared during debrief discussions. Through continuing to reflect on my time spent working in these environments during the pandemic so far, I hope to present my learning and recommendations for optimizing practice under challenging circumstances.

132 Assessment Tools to Measure Clinical Reasoning While Attending Simulation-Based Courses

Clinical reasoning is interconnected with decision-making which is a critical element to ensure patient safety [1]. To avoid practice mistakes, healthcare professionals should be competent with effective clinical reasoning skills. To develop effective clinical reasoning skills, healthcare professionals should get the chance to practise and be exposed to various experiences and levels of patient complexities. Simulation can immerse learners in scenarios that mimic clinical situations, simultaneously mitigating safety risks and increasing standardization in healthcare education [2]. Through simulation, learners can get the chance to practise clinical reasoning with focussed learning opportunities [3]. Several assessment tools have been used to measure clinical reasoning while attending simulation-based activities. However, we would like to explore the most valid and reliable tools to assess clinical reasoning while attending simulation, in addition to finding out whether these tools have considered the seniority and competency levels of their users.A scoping review was undertaken to answer the questions: What are the best available valid and reliable tools to evaluate clinical reasoning while attending simulation-based activities? Do we have valid and reliable clinical reasoning assessment tools for simulation that measure clinical reasoning considering different seniority and competency levels? We searched Medline, Scopus, Education Research Complete, and Google Scholar to identify relevant recent primary research conducted on this topic from 2000 onwards. The search included MeSH topics of: ‘Clinical reasoning’, ‘Simulation-based courses’ and ‘Clinical Reasoning tools’. The inclusion criteria were primary studies that described the use of tools measuring clinical reasoning while attending simulation-based courses. Two independent researchers agreed on the inclusion of the identified papers for full-text review. This review followed the review guidelines of Joanne Briggs institute.There are valid and reliable tools to evaluate clinical reasoning while attending simulation which is Clinical Reasoning Evaluation Simulation Tool CREST [1]; Lasater Clinical Judgment Rubric LCJR [4]; Creighton Competency Evaluation Instrument Creighton C-SEI- Tool [5]. However, the validity and reliability of these tools were tested on undergraduate student nurses, and there was no consideration for different seniority and competence levels, and applicability to other healthcare professions.There is an adequate number of tools to measure clinical reasoning while attending simulation. However, there is a significant basis to test the reliability and validity of these tools against different competence and seniority levels, and applicability to other healthcare professions.

150 ‘A Safe Learning Environment’: Simulation-Induced Stress Literature Review

Simulation-based education (SBE) is often celebrated as a safe learning environment, but this usually refers to the risk posed to patients, in this literature review the psychological safety for participants and the elements of SBE that generate or reduce stress are sought. Stress and learning have a complex relationship in adult learning; however, negative stress may inhibit memory formation and so the sustainable effect of SBE learning may be jeopardized by participants experiencing unnecessary stress during SBE. It is therefore important to identify the nature and trigger for stress in SBE to optimize this resource.Using the online database PubMed and the search terms (stress and anxiety) AND (Simulation) AND ((clinical education, medical education)) without limits on publication type or date, 20 articles were returned. A non-systematic review was undertaken. Articles that were designed to deliberately introduce stress into SMEs to gauge the effect on performance were excluded. Included studies analysed the type, characteristics and potential triggers of stress evoked through participation in SBE. 17 studies were retained.No studies in the UK were returned, SBE participants were from undergraduate and post-graduate settings and there was a mixture of professional groups included with three studies looking at team-based SMEs. Study design and method varied with an observational study being the most common method. Only one looked at qualitative data from focus groups of SME participants. Nearly all studies recorded a physical marker of stress – heart rate, cortisol level or visible signs of stress such as shaking hands. Two studies looked at techniques to actively reduce stress within the SBE activity; a mindfulness exercise before a task-based simulation and an introduction of a period of relaxation prior to debriefing. Faculty awareness of participant stress was measured objectively in only one study. SME design and equipment stressors were directly considered in two studies.There are limited dedicated studies addressing SBE-induced stress and how this can be modified; furthermore, a lack of research into faculty impact on stress hinders the opportunity to change. This was not a systematic literature review and so the findings are limited, but can help inform practitioners: (1) Repeated exposure and familiarity with SME reduce stress. (2) Designate roles that participants would be expected to undertake in real clinical scenarios. (3) Minimize distracting factors in the environment unless directly contributing to learning outcome. (4) Introducing a purposeful period of calm before debriefing may improve retention of learning outcomes.

189 A SIMULATION WITH NO PARTICIPANTS ONLY CO-FACULTY: USING SIMULATION FOR SYSTEMS INTEGRATION ON THE LARGE SCALE

The large-scale relocation of a paediatric hospital is a significant undertaking. New environments change the system, and ways of working must adapt to maintain quality healthcare. There are risks to patients and staff well-being, with high anxiety around change. There is evidence for the efficacy of simulation as a tool for safe training and rehearsal of staff and teams [1] but less so on such a large scale. Simulation for many is still perceived as a test of performance and a threat. We connected with the international simulation community to design a hospital-wide programme of Patient Environment Simulations for Systems Integration (PESSI). This paper outlines challenges in establishing buy-in from stakeholders and departments, developing a framework for implementation and our reflections on delivery of large-scale simulation activities to assist a hospital move.How can simulation-based methodology be used to support clinical departments on a large scale to adapt/integrate/prepare in moving to a brand-new hospital?Collaboration with authors of PEARLS for system integration use [1], using it as the main framework for delivery and structure of PESSI. Stages of delivery were: pre-phase work, system testing day, debrief/reflection and evaluation. Immediate feedback of enjoyment and learning was collated from all participants. Three-month post-move feedback is planned to review ongoing impact/behaviour change plus analysis of safety incidents.Pre-phase work involved meeting stakeholders and establishing aims of testing. Ward managers were key departmental links, meeting with members of PESSI to plan scenarios. System testing days involved familiarizing themselves with the environment, followed by ‘day in the life’ simulations with a representation of the whole team. All participants were called ‘co-faculty’ and knew exactly what would happen. Debrief involved facilitated conversations with the whole team describing reactions, and deeper analysis of the key events, with concerted efforts by facilitators to give a balanced approach of positives and challenges. A short report was given back to the department detailing the findings teams would need solutions to. Solutions from simulation were implemented prior to the move, increasing staff confidence, with many feeling PESSI played a major role in feeling prepared for the new site. The PESSI framework is being utilized in adult services and we hope to publish our methodology to share with the wider simulation community.

63 Virtual Community Outreach Simulation Programme

The community outreach programme paused during the global pandemic as schools were closed and we were unable to go into schools and colleges to use simulation-based training to educate and inspire young adults to consider a career in the National Health Service. Now that schools and colleges are open it is still difficult to go into schools and colleges due to COVID-19 restrictions. We needed a way to continue to reach out to these schools and colleges using simulation to educate and inspire young adults.The aim was to continue the outreach programme but virtually, via live streams and some pre-recorded simulations. Aiming to help to increase awareness of the different careers, routes into the National Health Service and skills required to work in healthcare. ‘A virtual learning environment is intended not simply to reproduce a classroom environment -’on-line’, but to use the technology to provide a new way of learning’, Britain and Liber [1]. By continuing to provide the outreach simulation project I hope to be able to engage with a larger number of learners at a single time.Streaming live simulations sessions with tutor groups from schools and colleges via platforms such as Microsoft Teams and Zoom using a variety of simulation scenarios. These simulations will be mainly focussing on human factors with some teaching on specific subjects depending on the need of the learners. Example: Virtual work experience for young adults interested in medicine. We plan to mock up our simulation centre to replicate an accident and emergency department and have three admissions of different severity. We will be streaming this to two schools simultaneously and they will have the chance to help prioritize the three patients and explain their choice. The simulations will display good teamwork, good communications skills and leadership. One of the simulations will not include these skills and display poor communication, this will be intentionally included in a simulation for the learners to identify.Feedback forms will be given to all learners to complete asking them if the session has inspired them to consider a career in the National Health Service, feedback will then be used to adjust the way we deliver the virtual side of the outreach programme and perfect the programme so we can continue to educate and inspire young adults.

130 Impact of Low-Dose High-Frequency in situ Simulation on Inpatient Diabetes Management: A Pilot Study

Even in the presence of established institutional guidelines, failure of compliance by the clinical teams plays an important role in the control of diabetes. The identified gaps include contextual and biomedical knowledge, attitudes, clinical inertia, confidence and familiarity with existing hospital resources and guidelines with regards to hospital diabetes care We wanted to demonstrate the efficacy of low-dose high-frequency The exercise was a 15-minute session, delivered during working hours to individual nurses. This consisted of a 5-minute scenario, involving a standardized patient followed by a 10-minute debrief. Modified Diamond-model debrief with an advocacy-inquiry model was used by the debriefer, a trained fellow in simulation, and overseen by an expert. The scripted scenario involved a patient with Diabetic Ketoacidosis (DKA), with learning outcomes of recognizing DKA, managing the patient and adhering to the institutional guidelines including management of hypoglycaemia. The scenario was individualized based on the roles of the participants. Pre- and post-questionnaires were given to the participants. The simulation was repeated twice in the second week and once in the third week.This mixed-method study was conducted in a UK teaching hospital, in a ward designated for patients with diabetes, as a part of a quality improvement programme. In the first week, patients with diabetes, admitted for DKA, were chosen and their blood sugar recordings, dysglycaemic episodes and adherence to guidelines were noted. Every week data were collected as in the first week. GNU pspp 1.0.1 [version 3] free software was used. The confidence scores were given as mean and standard deviation with confidence interval (CI) of 98.75%. A p-value of <0.0125 was considered significant based on the number of data points.The Dysglycemic episodes and protocol adherence from medical recordsConsidering the T2 (increased recognition of diabetic emergencies and adherence to protocol) and T3 (improved patient outcomes) outcomes, the methodology was recommended as a modality of training the nursing staff involved in inpatient care of patients with diabetes. Future programmes including multi-disciplinary teams, to explore teamwork and communication, are planned.