Primary care emergency team training in situ means learning in real context

A Literature Study of Medical Simulations for Non-Technical Skills Training in Emergency Medicine: Twenty Years of Progress, an Integrated Research Framework, and Future Research Avenues

Medical simulations have led to extensive developments in emergency medicine. Apart from the growing number of applications and research efforts in patient safety, few studies have focused on modalities, research methods, and professions via a synthesis of simulation studies with a focus on non-technical skills training. Intersections between medical simulation, non-technical skills training, and emergency medicine merit a synthesis of progress over the first two decades of the 21st century. Drawing on research from the Web of Science Core Collection's Science Citation Index Expanded and Social Science Citation Index editions, results showed that medical simulations were found to be effective, practical, and highly motivating. More importantly, simulation-based education should be a teaching approach, and many simulations are utilised to substitute high-risk, rare, and complex circumstances in technical or situational simulations. (1) Publications were grouped by specific categories of non-technical skills, teamwork, communication, diagnosis, resuscitation, airway management, anaesthesia, simulation, and medical education. (2) Although mixed-method and quantitative approaches were prominent during the time period, further exploration of qualitative data would greatly contribute to the interpretation of experience. (3) High-fidelity dummy was the most suitable instrument, but the tendency of simulators without explicitly stating the vendor selection calls for a standardised training process. The literature study concludes with a ring model as the integrated framework of presently known best practices and a broad range of underexplored research areas to be investigated in detail.

Creating psychological safety in interprofessional simulation for health professional learners: a scoping review of the barriers and enablers

Interprofessional simulation-based education (IP-SBE) supports the acquisition of interprofessional collaborative competencies. Psychologically safe environments are necessary to address socio-historical hierarchies and coercive practices that may occur in IP-SBE, facilitating fuller student participation. A scoping review was conducted to understand the barriers and enablers of psychological safety within IP-SBE. Research papers were eligible if they included two or more undergraduate and/or post-graduate students in health/social care qualifications/degrees and discussed barriers and/or enablers of psychological safety within simulation-based education. Sources of evidence included experimental, quasi-experimental, analytical observational, descriptive observational, qualitative, and mixed-methodological peer-reviewed studies. English or English-translated articles, published after January 1, 1990, were included. Data were extracted by two members of the research team. Extraction conflicts were resolved by the principal investigators. In total, 1,653 studies were screened; 1,527 did not meet inclusion criteria. After a full-text review, 99 additional articles were excluded; 27 studies were analyzed. Psychological safety enablers include prebriefing-debriefing by trained facilitators, no-blame culture, and structured evidenced-based simulation designs. Hierarchy among/between professions, fear of making mistakes, and uncertainty were considered barriers. Recognition of barriers and enablers of psychological safety in IP-SBE is an important first step towards creating strategies that support the full participation of students in their acquisition of IPC competencies.

GENESISS 1-Generating Standards for In-Situ Simulation project: a scoping review and conceptual model

BACKGROUND

In-Situ Simulation (ISS) enables teams to rehearse and review practice in the clinical environment to facilitate knowledge transition, reflection and safe learning. There is increasing use of ISS in healthcare organisations for which patient safety and quality improvement are key drivers. However, the effectiveness of ISS interventions has not yet been fully demonstrated and requires further study to maximise impact. Cohesive programmatic implementation is lacking and efforts to standardise ISS terms and concepts, strengthen the evidence base and develop an integrated model of learning is required. The aim of this study was to explore the current evidence, theories and concepts associated with ISS across all areas of healthcare and develop a conceptual model to inform future ISS research and best practice guidance.

METHODS

A scoping review was undertaken with stakeholder feedback to develop a conceptual model for ISS. Medline, OpenGrey and Web of Science were searched in September 2018 and updated in December 2020. Data from the included scoping review studies were analysed descriptively and organised into categories based on the different motivations, concepts and theoretical approaches for ISS. Categories and concepts were further refined through accessing stakeholder feedback.

RESULTS

Thirty-eight papers were included in the scoping review. Papers reported the development and evaluation of ISS interventions. Stakeholder groups highlighted situations where ISS could be suitable to improve care and outcomes and identified contextual and practical factors for implementation. A conceptual model of ISS was developed which was organised into four themes: 1. To understand and explore why systematic events occur in complex settings; 2.To design and test new clinical spaces, equipment, information technologies and procedures; 3. To practice and develop capability in individual and team performance; 4. To assess competency in complex clinical settings.

CONCLUSIONS

ISS presents a promising approach to improve individual and team capabilities and system performance and address the 'practice-theory gap'. However, there are limitations associated with ISS such as the impact on the clinical setting and service provision, the reliance of having an open learning culture and availability of relevant expertise. ISS should be introduced with due consideration of the specific objectives and learning needs it is proposed to address. Effectiveness of ISS has not yet been established and further research is required to evaluate and disseminate the findings of ISS interventions.

Simulation Training for Community Emergency Preparedness

Most infants and children who are ill and injured are cared for in community-based settings across the emergency continuum. These settings are often less prepared for pediatric patients than dedicated pediatric settings such as academic medical centers. Disparities in health outcomes exist and are associated with gaps in community emergency preparedness. Simulation is an effective technique to enhance emergency preparedness to ensure the highest quality of care is provided to all pediatric patients. In this article, we summarize the pediatric emergency care provided across the emergency continuum and outline the key features of simulation used to measure and improve pediatric preparedness in community settings. First, we discuss the use of simulation as a training tool and as an investigative methodology to enhance emergency preparedness across the continuum. Next, we present two examples of successful simulation-based programs that have led to improved emergency preparedness. [Pediatr Ann. 2021;50(1):e19-e24.].

GP decisions to participate in emergencies: a randomised vignette study

Background

GPs use their judgement on whether to participate in emergencies; however, little is known about how GPs make their decisions on emergency participation.

Aim

To test whether GPs' participation in emergencies is associated with cause of symptoms, distance to the patient, other patients waiting, and out-of-hours (OOH) clinic characteristics.

Design & setting

An online survey was sent to all GPs in Norway (n = 4701).

Method

GPs were randomised to vignettes describing a patient with acute shortness of breath and asked whether they would participate in a callout. The vignettes varied with respect to cause of symptoms (trauma versus illness), distance to the patient (15 minutes versus 45 minutes), and other patients waiting at the OOH clinic (crowding versus no crowding). The survey included questions about OOH clinic characteristics.

Results

Of the 1013 GPs (22%) who responded, 76% reported that they would participate. The proportion was higher in trauma (83% versus 69%, χ² 24.8, P<0.001), short distances (80% versus 71%, χ² 9.5, P=0.002), and no crowding (81% versus 70% χ² 14.6, P<0.001). Participation was associated with availability of a manned-response vehicle (adjusted odds ratio [OR] 2.06, 95% confidence interval [CI] = 1.25 to 3.41), and team training at the OOH clinic once a year (OR = 1.78, 95% CI = 1.12 to 2.82) or more than once a year (OR = 3.78, 95% CI = 1.64 to 8.68).

Conclusion

GPs were less likely to participate in emergencies when the incident was not owing to trauma, was far away, and when other patients were waiting. A manned-response vehicle and regular team training were associated with increased participation.

The current leadership development opportunities provided for student paramedics by Higher Education Institutions: a literature review

Introduction:

The development of safe, competent and capable paramedics is one of the key concerns of education providers or Higher Education Institutions (HEIs). To achieve this, paramedic programmes need to focus on teaching leadership to students. The aim of this literature review was to identify the current leadership development opportunities for paramedic students during their undergraduate training across the United Kingdom, in order to identify current gaps and make suggestions on how HEIs could increase leadership opportunities for student paramedics.

Methods:

During August 2018, the Scopus, Medline, CINAHL and Academic Search Premier databases were searched (the last three accessed via EBSCOhost). Grey literature was also manually reviewed. Both authors screened the title and abstract and agreed on final papers eligible for full-text review. CASP and COREQ checklists were used to assist in critically appraising the quality of the research and to help decide on the papers chosen for inclusion.

Results:

The search yielded 511 results (455 after duplicates were removed). The grey literature search also yielded one additional document that incorporated a framework based on primary research integrated within the paper itself. After title and abstract review, seven papers were included for full text critical review. Two papers were then excluded, resulting in a total of five papers being included in the review.

Conclusion:

Current evidence, although limited, demonstrates the benefit of educational programmes in developing educational and non-educational leadership opportunities for paramedic students. Moreover, there is value to individuals being provided or seeking extra-curricular activities, and students should be encouraged to engage in societies, the College of Paramedics, events and conferences, and to work or volunteer in healthcare or emergency service-related sectors to further enhance their leadership potential and skills.

An innovative approach to educating primary health care teams about medical emergencies

Management of emergencies is an integral part of primary care. However, the wide range of symptoms and the rarity of the situations make it difficult for primary care workers to be continually updated and competent in providing life support. In Ljubljana Community Health Centre, we use innovative approaches and modern teaching techniques to educate primary health care teams on how to manage medical emergencies.The three-level educational approach described here enables comprehensive education in managing and recognising dangerous medical situations. It also provides a safe way of learning how to manage difficult, uncommon and serious clinical situations.This comprehensive educational approach is oriented towards continuous improvement in quality and the safety of patients at the primary health care level.

Self reported involvement in emergency medicine among GPs in Norway

OBJECTIVE

To examine general practitioners' (GPs') perception of their role in emergency medicine and participation in emergency services including ambulance call outs, and the characteristics of the GPs and casualty clinics associated with the GPs' involvement in emergency medicine.

DESIGN

Cross-sectional online survey.

SETTING

General practice.

SUBJECTS

General practitioners in Norway (n = 1002).

MAIN OUTCOME MEASURES

Proportion of GPs perceiving that they have a large role in emergency medicine, regularly being on call, and the proportion of ambulance callouts with GP participation.

RESULTS

Forty six percent of the GPs indicated that they play a large role in emergency medicine, 63 percent of the GPs were regularly on call, and 28 percent responded that they usually took part in ambulance call outs. Multivariable logistic regression analyses indicated that these outcomes were strongly associated with participation in multidisciplinary training. Furthermore, the main outcomes were associated with traits commonly seen at smaller casualty clinics such as those with an absence of nursing personnel and extra physicians, and based on the distance to the hospital.

CONCLUSION

Our findings suggest that GPs play an important role in emergency medicine. Multidisciplinary team training may be important for their continued involvement in prehospital emergencies. Key Points   Health authorities and other stakeholders have raised concerns about general practitioner's (GPs) participation in emergency medicine, but few have studied opinions and perceptions among the GPs themselves.   • Norwegian GPs report playing a large role in emergency medicine, regularly being on call, and taking part in selected ambulance call outs.   • A higher proportion of GPs who took part in team training perceived themselves as playing a large role in emergency medicine, regularly being on call, and taking part in ambulance call outs.   • These outcomes were also associated with attributes commonly seen at smaller casualty clinics.

Patient safety culture in out-of-hours primary care services in the Netherlands: a cross-sectional survey

OBJECTIVE

To examine patient safety culture in Dutch out-of-hours primary care using the safety attitudes questionnaire (SAQ) which includes five factors: teamwork climate, safety climate, job satisfaction, perceptions of management and communication openness.

DESIGN

Cross-sectional observational study using an anonymous web-survey. Setting Sixteen out-of-hours general practitioner (GP) cooperatives and two call centers in the Netherlands. Subjects Primary healthcare providers in out-of-hours services. Main outcome measures Mean scores on patient safety culture factors; association between patient safety culture and profession, gender, age, and working experience.

RESULTS

Overall response rate was 43%. A total of 784 respondents were included; mainly GPs (N = 470) and triage nurses (N = 189). The healthcare providers were most positive about teamwork climate and job satisfaction, and less about communication openness and safety climate. The largest variation between clinics was found on safety climate; the lowest on teamwork climate. Triage nurses scored significantly higher than GPs on each of the five patient safety factors. Older healthcare providers scored significantly higher than younger on safety climate and perceptions of management. More working experience was positively related to higher teamwork climate and communication openness. Gender was not associated with any of the patient safety factors.

CONCLUSIONS

Our study showed that healthcare providers perceive patient safety culture in Dutch GP cooperatives positively, but there are differences related to the respondents' profession, age and working experience. Recommendations for future studies are to examine reasons for these differences, to examine the effects of interventions to improve safety culture and to make international comparisons of safety culture. Key Points Creating a positive patient safety culture is assumed to be a prerequisite for quality and safety. We found that: • healthcare providers in Dutch GP cooperatives perceive patient safety culture positively; • triage nurses scored higher than GPs, and older and more experienced healthcare professionals scored higher than younger and less experienced professionals - on several patient safety culture factors; and • within the GP cooperatives, safety climate and openness of communication had the largest potential for improvement.