Mastery Learning Conference
Report by Paul Fettes
A national program of Simulation Based Teaching of Practical Procedures by Mastery Learning
Larbert, 7 Sept 2016
32 delgates
Program
The Why
Introduction Michael Moneypenny
Director Scottish Centre for Simulation
The Case for a National Program Paul Fettes
Anaesthetist, Dundee
The What (what is already happening across Scotland)
The Lothian Mastery Learning Program James Tiernan
Physician, Edinburgh
BASICS Colville Laird
Director BASICS
Tayside Program Paul Fettes &
Achyut Valluri, Physician, Dundee
CVC Course RAH Paisley Paul Fettes on behalf of RAH team
Chest Ultrasound & Drains Anur Guhan, Physician, Ayr
The How (how do we progress from here)
Workshop 1 – Checklists Leads: James Tiernan, Chris Schnieke-
(workshops run twice, attended by all) Kind (Lothian Mastery Teaching Fellow)
Workshop 2 – Discussion forum Leads: Paul Fettes, Achyut Valluri
(Trainers and Trainees)
Q&A, Feedback and Action Plans Chair: Michael Moneypenny
Panel: James, Chris, Sam, Achyut, Paul
Conference Report
The fact that so many people attended this meeting in Larbert was an indication in itself that there is interest in the potential for developing a national program for simulation based teaching of practical procedures.
The audience came from all over Scotland, and included Clinical Skills staff, Resuscitation Officers, NES staff, consultants and trainees from various medical specialties, emergency medicine and anaesthesia, a surgeon. Some of the medical staff present filled roles such as Training Program Director, Deputy Director of Medical Education, Lead for development of Mastery Learning Program, as well as Director of BASICS and Director of the SCSCHF.
The Why
The morning started with the ‘Why’ create a national program? The need for simulation based teaching of procedures is recognised by trainees and by senior clinicians, and is recommended by several colleges and national organisations both in the UK and the US. The rationale for creating a national program is that we can work together to create standardised teaching across Scotland. It is appreciated that this will not be easy, but the obvious analogy is Life Support courses, which have faced similar challenges and have been tremendously effective. Hopefully there will be a benefit of improved communication, reduced duplication of effort, and improved standards.
The What
The ‘What’ is already happening followed next. There were reports from various centres, starting with James Tiernan from Lothian where there is already a well established mastery learning program for teaching of lumbar puncture, central venous catheter (CVC), and chest drain by mastery learning. He talked about mastery learning and what the program involved, and some of the challenges in setting up and running such a program. This was followed by Colville Laird, Director of BASICS who discussed the effective delivery of skills training to health professionals in remote areas with the aid of video conferencing. This was followed by presentations on the RAH Paisley CVC course which has very favourable feedback from attendees, and has been approved for CPD points; Chest drain and ultrasound by Anur Guhan from Ayr who is ground leading in this area; and the introduction of a mastery learning skills training program in Tayside with LP by Paul Fettes and results in AMU by Achyut Valluri, including some unexpected benefits with detection of use of wrong aseptic wash which has now been addressed, and adoption of spinal ‘packs’.
The How
After lunch all delegates attended two workshops.
The first (led by James Tiernan) was on Checklists, and demonstrated the importance of a checklist in evaluating performance (in this case of chest drain insertion) and the difficulties of creating a checklist in practice (even for a fairly simple procedure – in this case peripheral venous cannulation).
The second workshop (led by Paul Fettes) examined some of the challenges and potential solutions of creating a national program for teaching the practical procedures, with emphasis on the trainer, and the trainee. Delegates engaged very well in both workshops, and there was some very useful discussion. The main challenges were thought to be time, money, engagement, communication and knowing what is already happening. It was recognised that a ‘passport’ of having performed a skills to a satisfactory level on a manikin was only one stage in the process to safe and competent performance in a patient, but that such a passport could be recognised throughout Scotland, and could lead to better training opportunities for trainees. Such training could also be adopted for other groups such as medical and nursing students, nurses and allied health professionals. Trainer training and recognition would be vital and this would have to be standardised. Two suggestions for the latter were the use of the GMC RoT framework, and also the NES Clinical Skills Framework. It was also recognised that standardised training could lead to an evidence base which could enable research.
Q&A, Feedback and Action
There was active discussion followed by some agreed plans of action. Engagement and support at Medical Education and Healthboard level is important, and Lyndsey Donaldson, deputy DME for Glasgow offered to take a proposal to the next DME meeting.
It was recognised that there should be an overarching Mastery Learning Program committee to oversee standard processes and implementation, but that there would need to be a steering group for each individual procedure. Chris Schnieke-Kind agreed to write a generic SOP for teaching a procedure.
It was agreed that the attendees would form the basis of an online forum to maintain momentum from the conference in the way of e-mail dialogue, but more potential contributors should be actively recruited.
The role of NES was also discussed, and it was agreed that it would be great if CSMEN could support this program and host educational material on its website. It was recognized however that it would not be a role of CSMEN to develop the material.
It was agreed to have another meeting in 6 months time. More later on this.