Quality Assurance System

for the Use of Simulation in Clinical Skills Education

What is Quality Assurance (QA)?

Quality Assurancein educationisa systemofensuringthatquality management and quality control processes are in place within an organisation which can demonstrate training andmonitoring of standards.These processes also ensure there isa quality evidence base. QAidentifies where organisations are not meeting standards for simulation based education and trainingand outline options for promoting improvement.

The development ofa nationalstrategy forclinicalskillseducation in Scotland required aqualityassurancesystem tobe in placeforsimulationbased educationtoset up a continuousimprovementcultureofclinicalskillspracticeby individualsor teams ofhealth care practitioners. A Quality Assurance system ensuresthat standards ofsimulationbased education are accessible to all health care practitioners wherever they practice and whatever their professional background. The following information is framed around three questions

  • What QA frameworks have contributed to the development of a QA system for Simulation Based Education?
  • What is the Scottish Simulation Based Education QA System?
  • How was the QA System for Simulation Based Education developed?

What QA frameworkshave contributed to the development ofa QA system for Simulation Based Education?

The following sources have informedthedevelopment ofaQA system forSimulation Based Education. Each recognisesthe needtoensureeducational standardsarebeing continuously improvedand updatedforall healthcare practitioners.

  1. TheNursingandMidwiferyCouncil(NMC)

TheNMC updatedtheirQA framework foreducation in 2016. The principles for theframework include Transparency, Clarity, Utility, Accountability and Improvement. The standardsforthe approved programmes(over 100)it runs informstheirrole as a professional regulatorratherthan an educationalregulator which links intotheQualityAssurance Agency (QAA) forhighereducation. TheNMC regulates within a ‘righttouch’ regulation systemset outby theProfessionalStandardsAuthority (PSA). Righttouch regulation is definedas being proportionate, consistent, targeted, transparent, accountableandagile. In ordertoprovidepublicprotection as a professionalregulator it deliversQA through fourareas, as follows:

  • Approval against standards
  • Education reviews
  • Responding to concerns
  • Reporting and sharing evidence

NMC QA Framework for nursing and midwife education

  1. TheHealthProfessionsCouncil (HPC)

TheHPC isa regulator whichkeepsa registerof health care practitionerswhopracticetoan agreedstandard. It isa statutorybody which approveseducational programmes necessary‘toachievestandards ofproficiency’. It currently approves 94 education providers providing424 separateprogrammes.Thefollowingprofessionsare included:arts therapists, biomedical scientists, chiropodists/podiatrists, clinical scientists, dietitians, hearing aid dispensers, occupational therapists, operating department practitioners, orthoptists, paramedics, physiotherapists, practitioner psychologists, prosthetists/orthotists, radiographers, social workers in England and speech and language therapists. TheHPCiscurrently responding tothelatestEnhancingQuality In PracticeFramework (EQuIP).

HPC Healthcare Education QA Framework

  1. TheGeneral Medical Council (GMC)

TheGMC QAFramework coversbothundergraduateand postgraduateeducation andlinks intoPromotingExcellence thestandardsformedicaleducation and training

GMC Promoting Excellence

The QA systemclarifiesthe role ofNHS providers,HigherEducation Institutions (HEIs)Postgraduateproviders and Royal Colleges in Quality Assurance, Quality Management andQuality Control.

GMC QA Framework

  1. TheHigher Education Academy (HEA)UK

The HEAUK Professionals Standards Framework linksstandards ofeducationalactivitytocore knowledgerequirementsabouteducation and professional values with a focus on continuous improvement.

HEA UK Professionals Standards Framework

  1. The Academy of Medical Educators(AoME)

The AoMEset out to become the standard setting body for medical educators in the UK. In 2009, it achieved this aim with the publication of the Professional Standards that define the level of competence that medical educators should achieve at each point in their careers. The core domains they identified include

  • Designing and planning learning
  • Teaching and facilitating learning
  • Assessment of learning
  • Educational research and scholarship
  • Educational management and leadership

AoME Professional Standards

  1. SkillsDevelopment Scotland

SDShas developed an action plantemplate which islinked to improvement;the headings ofwhich are shown below.

SDS Quality Action Plan Template

Organisation: / Period of Action Plan:
Standards / Areas for Improvement to be Implemented / Individual responsible for Action / Date Action
Started / Finished / Resources Required / Review of Actions

The organisation coversa widevariety ofopportunities toenhancetheworkforce.

SDS What We Do

  1. The Association for Simulated Practice in Healthcare (ASPiH)

This UK organisation was established in 2012-13.

It has developed a standards Framework using an expert panel which was published in 2015 and focuses on four themes with 21 associated standards:

  • Resources
  • Faculty
  • Activity and
  • Technical personnel

ASPiH Standards for SBE in Healthcare

Howwas the Scottish QASystem for Simulation BasedEducation(SBE) developed?

In implementing the Scottish Clinical Skills Strategy in 2008 it wasessential toensurethat health carepractitionersfrom differentdisciplinesandfrom differentgeographicalareashadaccess tothesamestandards of SBEwhether delivered on the mobileskills unit,in fixed facilities or in situ in the workplace.

In 2009, the Clinical Skills Managed Educational Network began to explore a system for defining key quality standards for clinical skills education using simulation. A modified Delphi approach was used to develop consensus.

Thedevelopment ofa Scottish QAsystem for on line Clinical Skills resourcestoenhance SBE was developed in parallelwith thedelivery of faculty developmentand in relation tonational skills programme priorities building on the relevant frameworks highlighted in the previous section.

What istheScottish SBEQASystem?

This SBE QA Framework was developedto reflectthe following educationalprocess:

Brief

  • Faculty
  • A three-tiered approach was developed to identify key improvement outcomes
  • Tier 1- practitioner educators of SBE,
  • Tier 2 - leaders of SBE and
  • Tier 3- researchers of SBE (available to download)

This outcome framework has been matched vs AoME,ASPiH and GMC frameworks

  • Technical support
  • A modified Delphi approachis being used to identify nationally agreed capabilities for all Simulation technicians (available download in development)
  • Facilities
  • A national database of facilities and their capabilities in terms ofspecialist equipment has been developed
  • A mobileskillsunit(MSU) withthe sameaccesstovideodebriefing and standard simulatorsandpart task trainers is operational
  • Resources
  • A generic approach to on line development of clinical skills has been agreed and utilisedin the development of evidencebased on lineresources CS MEN online resources

Immersion

  • Programmes
  • A self-assessment questionnaire to be used for Quality Assurance of educational programmes
  • A one-page questionnaire for use with individual skills sessions where simulation is used
  • Provision of QA programmes on MSU e.g. BLS, ALS, PROMPT
  • Scenarios
  • A scenario template fordesigningaSBE session has been developedtoensurestandards ofdesign areconsidered in thedevelopment ofnewscenarios
  • Specialist equipment
  • standard manikins andparttask trainers in all SBE facilities
  • one way mirrorandvideodebriefing capability in all SBE facilities

Debrief

  • System of review and improvement
  • On lineresourcescurrently updated biannually
  • System of visits to remote and rural venues by MSU
  • A nationalcourse forthe MSU has been implemented
  • A nationalfaculty database isbeingdeveloped

The common quality standards, educational resources and training programmes developed and delivered through theScottish QA system for SBE are subject to an independent, robust and open review process. This will give the public and health service managers confidence in the quality of clinical skills education and delivery and enable the skills training to be explicitly linked with UK and Scottish competency frameworks.

Clinical skills training impacts directly on the quality of care patients receive. Patientsare the ‘touch point’oftheservice. Consequently, the quality assurance process must encompass not only educational governance but clinical and staff governance issues as well. In Scotland, Quality Improvement Scotland (QIS) is responsible for promoting patient safety through ensuring clinical standards of care. NHS QIS is committed to working collaboratively on the development of the Clinical Skills Managed Educational Network as we seek to promote best practice and improve the quality of healthcare.

NES has responsibility for providing and promoting education to all NHS staff and has developed an educational governance framework for ensuring that educational resources and processes can be measured against explicit quality standards and criteria. The Scottish QA system for SBE underpins the implementation of the Scottish Clinical Skills Strategy.