NHS Lothian Clinical Skills Mastery Programme
Implementing safe and effective clinical performance James Tiernan June 2014 Quality Education for a Healthier Scotland
Postgraduate Clinical Procedural Skills
Is there a problem? Quality Education for a Healthier Scotland
Learning and teaching skills is a challenge
Quality Education for a Healthier Scotland
One Approach:
The skills carousel
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An alternative approach:
Lothian Clinical Skills Mastery Programme
• Why?
Many trainees are not achieving procedural competencies
• How? • What?
A skilled team to facilitate learning via safe, simulated practice.
The Mastery Programme Quality Education for a Healthier Scotland
Knowledge
Skills Safety Drills
Performance Quality Education for a Healthier Scotland
Intended Learning Outcomes Trainees After participation in the mastery programme, the doctor in training will have the skills required to achieve competency in mandatory and desired procedural skills to the level of safe clinical performance under supervision.
Tutors After participation in the mastery programme, the faculty clinicians will be able to teach clinical procedural skills to doctors in training in an effective and structured fashion, receiving appropriate recognition for their contributions.
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Unskilled Doctor
Faculty Development + Accreditation
Knowledge + Video Packs
Task Trainer Lab Sessions
(On line)
Task Trainer In-Situ Sessions
Supervised + Video
Co-ordination via Online Booking System + Sessional Checklist Skills Assessment
Supervised + Video
Ongoing Clinical Practice
Supervised
Competent DoctorQuality Education for a Healthier Scotland
Education Packs •
Reading and Video
•
Online – New MED Website
•
Checklists – Formative assessment
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TUtorial Booking System “TUBS” • https://tutorialbooking.com •
Advertise a session
•
Sign up to sessions
•
Automatic feedback generated
•
Teaching Log generated for ARCP
•
All of SE Scotland
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Skills Lab Session •
1 Trainee + 1 tutor
•
Discussion of experience and concerns
• Lab environment • Demonstration • Practise •
Feedback
•
Trouble shooting and discussion
• Establish motor skills + clinical decision making Quality Education for a Healthier Scotland
Clinical Session (In situ) •
30mins - 1hr
•
1 Trainee + 1 tutor
•
PAA / ARU / PAA
• Full Asepsis + Drapes • Entire procedure under supervision •
Feedback
•
Trouble shooting and discussion
• Establish simulated safety and competence Quality Education for a Healthier Scotland
Faculty Induction and Development
via The Clinical Educator Programme Quality Education for a Healthier Scotland
Faculty Right Person – Right Skill – Right Way – Right Place – Right Time
• Consultant / Registrar / Specialty Doctors facilitators – ST3+ – Anaesthetics / ITU / Medical specialties / A&E
• Skill-specific • Induction process – – – –
Introductory session Observation Facilitation (supervised) Facilitation (unsupervised)
• Accreditation via Clinical Educator Programme – Recognised for ARCP / CPD
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How can we effectively teach procedural skills?
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The Challenge: TRANSFER
Quality Learning for Quality and SafetyEducation
for a Healthier Scotland
Johari Window Conscious Competence
Conscious Incompetence
Unconscious Competence
Unconscious Incompetence
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Quality Learning for Quality and SafetyEducation
for a Healthier Scotland
Break it Down
Bite Size Chunks Quality Education for a Healthier Scotland
Procedural Phases 1.
Preparation, Assistance and Positioning Non technical skills + clinical decision making
2.
Asepsis + Anaesthetic
3.
Procedural Pause 3 Point Check
4.
Insertion
5.
Anchoring + Dressing
6.
Completion Documentation / Communication / Trouble shooting
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Non- Technical Skills Category
Element
Gathering Information
Situation Awareness:
Pause to interpret information Projection to future states Generating Options
Decision Making:
Balancing Options Reviewing of Decisions Prioritising (tasks and patients)
Getting the Job Done:
Maintaining Standards Planning and preparing
Mellanby et al. 2013
Utilising Resources Speaking up
Teamwork:
Establishing shared understanding Establishing a team
These allow effective and timely
Escalation of care Quality Education for a Healthier Scotland
Evidence Base
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Evidence Base - Outcomes • T1 - Lab measurements – Thoracocentesis / LP / Paracentesis • T2 - Patient care practices – CVC / Laparoscopy • T3 - Patient outcomes – Bacteraemia, ITU admissions, LOS • T4 – Collateral effects – Cost savings, Other trainees McGaghie et al. 2014, Medical Education
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Mastery Programme LP Study Aims – To demonstrate: • Improved performance of LP via Mastery methodology – Safety – Sterility – Success
• Impact of environment on simulated performance – Added value of in-situ training Quality Education for a Healthier Scotland
Mastery Programme LP Study Reading and Video Learning Phase 1 Lab Skills Session Group A
Group B
Lab Skills Session
In Situ Skills Session
Assessment In Situ
Phase 2
Phase 3
Follow Up Questionnaire / Interview Quality Education for a Healthier Scotland
Progress • Sessions • Faculty • Feedback • Study outcomes TBA
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Next Steps • Expansion into other trainee groups • Inclusion of other skills
Straight forward
• Faculty expansion – Multi-professional tutors
• Enhancing faculty + time protection
Challenging
• Evaluation of Clinical Outcomes
• Mastery Model – Mandating simulated competency prior to real life
Culture change
Quality Education for a Healthier Scotland
Unskilled Doctor
Faculty Development + Accreditation
Knowledge + Video Packs
Task Trainer Lab Sessions
(On line)
Task Trainer In-Situ Sessions
Supervised + Video
Co-ordination via Online Booking System + Sessional Checklist Skills Assessment
Supervised + Video
Ongoing Clinical Practice
Supervised
Competent DoctorQuality Education for a Healthier Scotland
Safety, Sterility and Success
Thank you
[email protected] Quality Education for a Healthier Scotland
