Non-technical Skills Training in Synthetic Learning Environments
Final Report
on
Specialist Trainees in Synthetic Training Environments Project
on behalf of
A project funded by the Commonwealth of Australia as represented by the
Department of Health and Ageing
Table of Contents
Definitions 5
Project outcomes 8
1 Introduction 8
2 Summary of Project Outcomes and Key Findings 10
2.1 Project governance and management 10
2.2 Curricula Mapping: Evidence (Literature Review) 10
2.3 Curricula Mapping: Engagement 11
2.4 Curricula Mapping: Resource development 12
2.5 Curricula Mapping: Adoption and Pilot Courses 15
2.6 Curricular distribution & Sharing 17
2.7 Issues regarding each of the medical specialties examined 19
2.8 Priorities for non-clinical skills development of specialist trainees 20
2.9 Key principles, opportunities and barriers in relation to specialist training in synthetic training environments 21
3 Recommendations 23
Background 28
4 Project Overview 28
4.1 Objectives and Requirements 28
4.2 Allocation of roles among project suppliers 29
5 Project Ownership 30
6 Project Funding 31
Project Governance 32
7 Project Board 32
8 Project Management 32
8.1 Initial Project Plan (Pre Novation) 32
8.2 Revised Project Plan (Post Novation) 33
8.3 Revised Project Plan - Schedule 34
8.4 Risk Management 37
8.5 Change Management 38
8.6 Quality Management 38
- Project Supplier Status Reports 42
9 Project Suppliers 43
10 Engagement Process for Key Suppliers 44
10.1 Procurement Consultant 44
10.2 Principal Consultant 45
- Tender Advertisement 46
- Tender Responses 46
- Tender Evaluation 46
- Contracting 47
10.3 Specialist Colleges participating in Curriculum Mapping (Resource Development) and Pilot Training Courses 48
- Restricted EOI Advertisement 48
- EOI Responses 48
- Evaluation of EOI Responses 48
- Contracting 49
10.4 Providers of Pilot Courses 49
- Request for Quotation Advertisement 49
- Request for Quotation Responses 49
- Evaluation of Submissions 49
- Contracting 50
10.5 Curricula Distribution, Curricula Sharing 50
11 Progress Reports to DOHA 50
11.1 Report at 10 June 2007 50
11.2 Report at 31 December 2007 50
11.3 Report at 27 August 2008 50
12 Project Governance Outcomes 50
Project Delivery 52
13 Curricula Mapping 52
13.1 Evidence (Literature Review) 52
- Aims 52
- Methods 52
- Results 52
- Key findings: Aim 1) Incorporation of NTS into specialist training curricula internationally 52
- Key findings: Aim 2) Methods and modalities of training NTS utilising simulation 53
- Key findings: Aim 3) Evidence supporting specific methods or modalities for specified learning objectives or medical specialities. 53
- Key findings: Aim 4) Issues influencing the integration of simulation training into clinical training 54
- Conclusions 54
- Recommendations 54
13.2 Engagement 55
- Aims 55
- Methods 55
- Engagement Forum August 7 2008 55
- Liaison with specialist training colleges 57
- Self Assessment Process 58
- Summary of Outcomes of the Engagement Component 60
13.3 Resource Development 60
- Aims 60
- Training Needs Analysis (TNA) 60
- Recommendations from the resource development component 64
- Appropriate simulation methods that can be employed to address these needs 65
- Conceptual models for curricula which integrate simulation into existing training curricula 65
- Problem-Based Model for Risk-Benefit Analysis 67
13.4 Pilots & Adoption 68
- General Aims 68
- General description of the courses 68
- Description of the methodology used in the independent evaluation of the courses by the Principal Consultant 69
- Description of the Pilot Course for the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) 69
- Description of the Pilot Course for the Joint Faculty of Intensive Care Medicine (JFICM) 70
- Description of the Pilot Course for the Royal Australasian College of Surgeons (RACS) 71
- Evaluations 71
- Independent Pilot Evaluation of the RANZCO Pilot Course 73
- Independent Evaluation of the JFICM Pilot Course 74
- Independent Evaluation of the RACS Pilot Course 75
- Recommended features of future courses based on positive and negative findings 77
13.5 Curricula Mapping Project Checklist 78
14 Curricula Distribution & Sharing 79
14.1 Overview 79
14.2 Aims 79
14.3 Curricula Distribution Forum 80
14.4 Opportunities 81
14.5 Constraints 82
14.6 Models 83
- Curricular Attributes models 83
- Curricula Funding Models 84
14.7 Principles underlying successful models 84
14.8 Project Checklist 85
Project Acquittal 86
15 Requirements – Phase One 86
15.1 Outcome 86
16 Requirements – Phase Two 87
16.1 Outcome 87
17 Reporting Requirements 89
18 Other Requirements 89
19 Project Financials 90
19.1 Budget vs. Actual 90
List of Attachments 91
Definitions
1. ASSH: Australian Society for Simulation in Healthcare2. Clinical skills, in this document, refer to domain specific components of clinical practice directly required including but not limited to:
- Patient assessment and clinical diagnostic reasoning
- Judgement and decision-making regarding therapy
- procedural knowledge and technical skills relevant to execution of procedures
3. EMEAC: Enhanced Medical Education Advisory Board
4. ESTP: Expanded Specialist Training Program
5. Learning methods used in (SLEs) include, without being limited to:
a. Scenarios - Using any of the above technologies to enact whole events or components of events.
b. Case-based learning – using other formats including written and oral presentations, to present clinical scenarios for learning.
c. Role play – Using any of the above technologies to enact interactions between people, including but not limited to:
i. health professionals and patients (E.g doctor–patient; nurse-patient)
ii. Health professionals and health professionals
d. Procedural training - Using any of the above technologies as a platform from which to conduct a procedure.
e. Multimodal formats – refer to activities which integrate two or more discrete techniques or curricula which use a variety of specific formats to address specific individual learning objectives.
f. Debriefing and reflection
6. Learning technologies used in (SLEs) include, without being limited to:
a. Manikin – life-like aspects of people and situations are generated by a manikin and or a “theatrical” interaction of actors and props with manikins.
b. Computer-based virtual reality – a realistic environment is reproduced on a computer screen.
c. Haptics (tactile information is fed back to the learner (E.g. feel of surgical instruments on tissue)
d. Actors – reproduce components of real world experience, especially involving communication between people
- Part-task trainers – reproduce components of a patient’s anatomy. They are generally used to support procedural skills training however may be used in conjunction with other learning technologies to create integrated clinical situations.
f. Video – actual real world, or any of the above enacted on video
7. Non-technical skills (NTS), in this document refer to cognitive functioning and observable behaviours that underpin safe and effective clinical practice. They include without being limited to the following:
- communication (patient-doctor, team)
- leadership
- teamwork
- situation awareness and decision-making
- resource management
- safe practice, adverse event minimization/ mitigation
- professionalism
8. SIAA: Simulation Industry Association of Australia
9. Simulation in this document refers to learning methods provided in SLEs which support experiential learning. Key components of experiential learning include:
a. the learner interacts with his or her environment.
b. A high proportion of the learning activities enact activities and tasks representative of the learner’s real world responsibilities.
c. The environment needs to be sufficiently realistic for experiential learning to occur. Depending upon the learning objectives, realism can be built into the equipment, the surrounding environment or the overall integration of equipment, environment and interactions between learners and instructors [1]
10. Synthetic learning environment (SLE) – an area, used for the purpose of learning and related activities, the latter including research into, assessment and evaluation of learning, which reproduces components or aspects of the real world environment, to support learning.
11. Synthetic learning - any learning undertaken in a SLE.
12. Specialist colleges targeted to participate in this initiative comprise:
- Australasian College of Dermatologists (ACD)
- Australasian College of Emergency Medicine (ACEM)
- Australian and New Zealand College of Anaesthetists (ANZCA)
- ANZCA - Joint Faculty of Intensive Care Medicine (JFICM)
- ANZCA - Faculty of Pain Medicine (FPM)
- Royal Australasian College of Medical Administrators (RACMA)
- Royal Australasian College of Physicians (RACP)
- RACP - Australasian Chapter of Palliative Medicine (ACPM)
- RACP - Australasian Faculty of Rehabilitation Medicine
- RACP - Australasian Faculty of Occupational Medicine (AFOM)
- RACP - Australian Faculty of Public Health Medicine (AFPHM)
- RACP - Paediatrics & Child Health Division (PCHM)
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG)
- Royal Australian and New Zealand College of Ophthalmologists (RANZCO)
- Royal Australian and New Zealand College of Psychiatrists and the Faculties of Child and Adolescent Psychiatry, and Old Age (RANZCP)
- Royal Australian and New Zealand College of Radiologists and the Faculty of Radiation Oncology
- Royal Australasian College of Surgeons (RACP)
- Royal College of Pathologists of Australia (RCPA)
13. Specialist colleges not targeted in this initiative comprise:
- Royal Australian College of General Practitioners (RACGP)
- Australian College of Rural and Remote Medicine (ACRRM)
14. Vocational specialist trainee – a medical practitioner undertaking post graduate training for the purpose of qualifying as a Fellow of a medical specialist college. The training is in accordance with the curriculum of the relevant accredited specialist college.
Project outcomes
1 Introduction
The Expanded Specialist Training Program (ESTP) is an Australian Government sponsored initiative that supports medical specialist training in a range of settings that expand upon the traditional public sector teaching hospital ward environment.
Synthetic learning environments (SLEs) are learning spaces supporting technologies that replace patients and which reproduce aspects of the real world environments that patients inhabit, including operating theatres, hospital wards, outpatient clinics, and consulting rooms. SLEs are eligible as expanded settings under the ESTP. A range of learning technologies can be used as alternative to patients including mannequins, actors, virtual reality systems and cadavers. Synthetic learning is any learning undertaken in a SLE. Simulation training comprises highly interactive learning methods whereby patient presentations and situations are presented with sufficient realism to enable learners to practice a wide range of tasks representative of their professional responsibilities. Narrative is an important characteristic of simulation. The narrative is presented in scripted scenarios providing the virtual patient’s individual storyline – the principles of which are similar to those of traditional class room style case-based and problem-based learning – but in a format that is acted out, enabling practice. Another important feature of simulation is reflection upon practice which is generally facilitated by a trained instructor. All of these elements are recognised to promote effective and deep learning. While realism is an essential pre-requisite for learning, it is important to note that the “fidelity” of this realism shifts from the patient technology to the virtual ward and, or, the interactions between actors playing out the scenario, depending upon the learning objectives. This affects the required complexity and sophistication of technology, laboratory setting and stage management of actors, respectively.
Simulation has numerous proven benefits and can be used strategically in curricular design to enhance workplace learning, however, unlike traditional clinical apprenticeships, SLEs are not widely utilised to train specialist trainees. Subsequently, there is a lack of experience, know-how and evaluative evidence to guide specialist colleges that may entertain this as an option. Factors contributing to low utilization of simulation-based training include:
· Low awareness of its potential
· Inadequate understanding by curriculum designers and clinical teachers of how it can be incorporated into curricula and training activities
· Lack of awareness of (or access to) appropriate learning technologies and facilities
· Lack of knowledge of factors underpinning purchasing decisions and evaluation of its impact and value for money
· Perceived (or actual) lack of infrastructure, funding and other resources, and
· Low engagement by stakeholders.
To optimise utilisation of SLEs for specialist training, the project sponsors concluded that further information was required on the barriers, opportunities and issues associated with training specialists in SLEs, and initiatives were perceived to be required that promoted the utilisation of simulation-based training by specialist training colleges. In particular, there is a perceived benefit in utilising simulation to promote training of non-technical skills (NTS). NTS - including communication, leadership, teamwork, crisis resource management (CRM), professional behaviours, cultural awareness and ethical reasoning - are recognised to underpin safe and effective clinical practice; and while specialist training colleges’ curricula generally address NTS, few colleges appear to have developed formalised structured training methods to achieve these competencies.
This initiative, the Specialist Trainees in Synthetic Training Environments Project (the Project) aimed to address the above issues. The project was conducted by the Australian Society for Simulation in Healthcare (ASSH), a chapter of the Simulation Industry Association of Australia (SIAA).
The specific requirements for the project are detailed in Section 4 (Project Overview) of this report. In brief, the project was divided into two main components shown in the table:
Curricula developmentPhase 1
1. Evidence - Undertaking a literature search of the potential role of synthetic training environments in “non-technical skills” development for Australian medical specialist trainees.
2. Engagement - Encouraging Australian medical specialist colleges to explore these potential roles.
3. Resource development - Supporting up to six colleges to work constructively with a designated project team appointed by ASSH to develop new curricula for specialist trainees which include simulation for non-technical skills.
Phase 2
4. Adoption - Undertaking a limited number of pilot training activities for the colleges participating in the “resource development” component of the project which involve content experts, key stakeholders, simulation providers and medical educators with the aim of encouraging the specialist colleges to adopt the key findings of Phase 1.
Curricula distribution
1. To identify opportunities, constraints and key principles underlying successful models for distributing simulation training curricula for specialist trainees of Australian medical colleges as part of the broad aim to achieve uniform training standards, acceptable access to training and efficient and economical business models for simulation training.
As required by the Funding Agreement this report presents a summary of all work, key findings and recommendations, including the components outlined in the above table and the following: