NHS Lothian Clinical Skills Mastery Programme

transcript

Quality Education for a Healthier Scotland

James TiernanJune 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

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

Knowledge

Skills

Drills

Performance

Safety

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.

Unskilled Doctor

Knowledge + Video Packs

(On line) Task Trainer Lab Sessions

Ongoing Clinical Practice

Competent Doctor

Task Trainer In-Situ Sessions

Supervised + Video

Faculty Development + Accreditation

Supervised

Co-ordination via Online Booking System

SessionalChecklist

Skills Assessment

Education Packs

• Reading and Video

• Online– New MED Website

• Checklists– Formative assessment

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

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

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

Faculty Induction and Development

via The Clinical Educator Programme

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

How can we effectively teach procedural skills?

The Challenge: TRANSFER

Learning for Quality and Safety

Johari Window

Conscious Competence

Conscious Incompetence

Unconscious Competence

Unconscious Incompetence

Development

Learning for Quality and Safety

Break it Down

Bite Size Chunks

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

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

Evidence Base

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

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

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

Progress

• Sessions

• Faculty

• Feedback

• Study outcomes TBA

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

Unskilled Doctor

Knowledge + Video Packs

(On line) Task Trainer Lab Sessions

Ongoing Clinical Practice

Competent Doctor

Task Trainer In-Situ Sessions

Supervised + Video

Faculty Development + Accreditation

Supervised

Co-ordination via Online Booking System

SessionalChecklist

Skills Assessment

Safety, Sterility and Success

Thank youjames.tiernan@nhs.net

NHS Lothian Clinical Skills Mastery Programme

Documents