ASSET Centre UCC Galway July 2012

John McAdoo Medical Director ASSET Centre University College Cork

Introduction

We are what we repeatedly do

Excellence is not an act, but a habit

Aristotle

Ether Dome 1846

Photo from the Mass General Site

Halstedian Training

Apprentice Model

21st Century Competency Based Healthcare Training and Assessment

Simulation Training UCC Why Now?

• Progressive decrease in traditional clinical learning opportunities for health professionals

(Explicit patient covenant, legislation such as EU Working Time Directive, Health Service Reconfiguration)

• Worldwide move from time-based to competence-based training in healthcare

• Legislation which requires implementation of mandatory professional competence schemes

• Current or future mandatory recertification/revalidation of health professionals

• Routine Disclosure of Trainee Participation and Its Effect on Patient Willingness and Consent Rates

Ref Christopher R. Porta et al Arch Surg. 2012;147(1):57-62

Simulation Training UCC Why Now?

• Medical "inflation" - increase in the rate of development of new techniques, procedures, devices with evidence of (or licensed to) improve patient care.

• The bodies responsible for licensing medical devices will require evidence of valid reliable forms of assessment of the use by individual practitioners.

• The FDA recommends validation and human factors testing in a simulated environment as part of any pre-market approval application. (FDA draft guidance January 2012)

Simulation Training UCC Why Now?

• Expectations as outlined in the Buttimer Report

Provide for the necessary infrastructural and ICT investments and virtual laboratories at an early stage (Buttimer Report, Ireland)

International Simulation Training

• Simulation based training has already been mandated by the Accreditation Council for Graduate Medical Education (ACGME) (Beall, 1999)

• Australia as part of a $1.5 billion investment in healthcare education

• $46M will be allocated in 2010-11 to support SLE capital establishment $48M will be allocated to revenue costs

• The program will have an annual allocation of $20m Ref Mark Cormack: Head of Health Workforce Australia, Health Workforce Australia website

March 2011

Medical Simulation UK

• Simulation offers an important route to safer care for patients and must be more fully integrated into the health service.

• This framework clearly states that healthcare professionals, as part of a managed learning process and where appropriate, should learn skills in a simulation environment and using other technologies before undertaking them in supervised clinical practice.

Liam Donaldson 2008 CMO UK

Team Training

• Patient care depends on high functioning teams.

• We must ensure that technological approaches are used to support teams training together.

• Simulation in particular allows teams to practise safely and reduces the risk of complications for patients.

(A Framework for Technology Enhanced Learning DoH UK) Dame Sally Davies CMO UK

TE Simulation the Evidence

• Technology-enhanced simulation training in health professions education is consistently associated with large effects for outcomes of knowledge, skills, and behaviours and moderate effects for patient related outcomes.

Ref Technology-Enhanced Simulation for Health Professions Education A Systematic Review and Meta-

analysis Cook et al JAMA, September 7, 2011—Vol 306, No. 9

• SBME with DP is superior to traditional clinical medical education in achieving specific clinical skill acquisition goals

Ref Does Simulation-based medical education with deliberate practice yields better results than traditional

clinical education:? A meta-analytic comparative review of the evidence.

McGaghie WC, et al Acad Med. 2011 Jun;86(6):706-11

ASSET Centre Hub and Spoke

Objectives of ASSET Centre

• A capacity resource to UCC • Team Training and Human Factors CRM Courses • High fidelity skills training • Standard courses eg ACLS etc • Medium fidelity and clinical skills training • Opportunities for deliberate skills practice • Assessment • CPD – Self Directed Learning • Research • Critical event management • Multidisciplinary and inter-professional/disciplinary training and

education • Proficiency-based progression • Train the Trainer Courses

Research

• Formative Assessment

• Summative Assessment

• High Stakes Assessment

Fifth Year Medical Students Feedback

Interns Feedback

Postgraduate Structured Feedback

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Questions?