Simon Edgar

Optimising clinical performance during resuscitation using video evaluation

Video evaluation of resuscitation is becoming increasingly integrated into practice in a number of clinical settings. The purpose of this review article is to examine how video may enhance clinical care during resuscitation. As healthcare and available therapeutic interventions evolve, re-evaluation of accepted paradigms requires data to describe current practice and support change. Analysis of video recordings affords creation of a framework to evaluate individual and team performance and develop unique and tailored strategies to optimise care delivery. While video has been used in a number of non-clinical settings, there has been a recent increase of video systems in the prehospital and other clinical areas. This paper reviews the key opportunities in the emergency department-based resuscitation setting to enhance ergonomics, technical and non-technical skills—at both team and individual level—through video-assisted care performance analysis and feedback.

How to implement live video recording in the clinical environment: A practical guide for clinical services

The use of video in healthcare is becoming more common, particularly in simulation and educational settings. However, video recording live episodes of clinical care is far less routine.

21st century medical education: critical decision-making guidance through smartphone/tablet applications—the Lothian pilot

Introduction In starting a new clinical placement, doctors in training must become aware of and apply standard operating procedures, as well as learn guidelines, simultaneously adjusting to new patient presentations, environments and personnel. This transition is thought to correlate with increased risk to patient safety, notably during the annual UK changeover. Mobile technologies are increasingly commonplace throughout the National Health Service. Clinicians at all levels are employing medical technology and applications (apps) with minimal local guidance. We set out to test the feasibility and utility of offering medical apps to out-of-hours (OOH) practitioners as an aid to clinical decision-making at point of patient contact. The theorised benefits were threefold: clinical education—real time support for clinical decision-making as one component of deliberate practice to build expert performance; decreased administrative burden–updating and accessing current guidelines; and service development—readily accessible feedback from users. Method We provided 32 devices in our emergency departments and OOH environments. The devices were preloaded with apps approved by our medical education department and clinical service leads to be used in support of care delivery. Results We surveyed 123 clinical staff prior to the pilot discovering that 65% had used mobile apps to aid their decision-making. During our project, we saw the number of clinical users expand with our data series, suggesting the apps most useful to care delivery for this group of service providers. Future developments There was huge enthusiasm for the project and we hope to maintain a clinician-led environment.

0169 Tunnel Vision: How Good Are Final Year Medical Students In Identifying Differential Diagnosis On A Busy Ward Round: A Simulated Ward Round At The University Of Edinburgh

Background Ward rounds are a busy and complex environment. Aggressive patients can be either distracting to the participants, and often their behaviour can be attributed to personality traits. However, it is common knowledge amongst medical healthcare professionals that it is potentially a symptom of an organic cause. Therefore, is a complex and stressful environment, with multiple tasks to be performed, how likely is a medical student to identify the potential of a serious illness in an aggressive patient. Methodology We ran a simulated ward round at the university of Edinburgh involving final year medical students (n = 290). We used five patient scenarios with numerous distractors such as phone calls, being asked to perform other tasks, and requesting investigations, as well as being a part of the ward round. Two of the scenarios used were around one patient with acute pancreatitis and another with sepsis and airway compromise. Both these simulated patients were instructed to be aggressive. We measured the time between the patient expressing symptoms to the time of considering a possible cause of the patient’s symptoms, and also the number of prompts from faculty and the patients required to do so. The wards rounds included approximately 3 to 5 students, and each ward round was followed by a reflective debrief. Results The busy environment in addition to the distractors played a major role in delaying the differential diagnosis, and also the required number of prompts. It was interesting that during the debrief sessions the students immediately suspected the issue if they were in a calm and distractor-free environment. Potential impact The appropriate understanding and acquisition of non- technical skills are an important factor is diluting distractors and avoid potentially disastrous outcomes. Work around the subject should be continued in the future as part of the undergraduate curriculum. References Flin, R, O’Connor P, Crichton M. Safety at the Sharp End: A Guide to Non-Technical Skills. Surrey: Ashgate; 2008 Fulde, G, 2011. Managing aggressive and violent patients. Australia Prescriber

0189 Simulated complex clinical procedural skills in situ – Bridging the gap between the lab and real clinical practice

Background Postgraduate medical curricula contain mandatory procedural skills, including lumbar puncture, thoracocentesis and central venous cannulation. Simulated skills training can improve technical ability in laboratories but does this ensure safe clinical performance? We propose that the environment significantly affects procedural skill performance, and that using simulation in the ‘real-life’ clinical environment will bring us closer to ensuring safe and successful practice. Methodology The NHS Lothian Clinical Skills Mastery Programme was introduced in Edinburgh in 2013. For each procedural skill, trainees receive knowledge packs (written and video resources) and a 2-phase supervised simulated training programme. Phase 1: Skills lab (non-clinical) Phase 2: In situ (clinical environment) We are currently studying the development of a complex clinical procedural skill (lumbar puncture) by our trainees via our Mastery methodology, with particular focus on the impact of the environment on performance. This study takes the form of a randomised control trial, using 2 groups of candidates: Lab Simulation ‘vs. In Situ Simulation. Both groups undergo a series of formative, standard-set, checklist-based assessments, culminating in an assessment of simulated performance in situ. Results A combination of quantitative and qualitative data from our study will be presented. Conclusions and recommendations ‘Mastery Learning’ has an evidence base to support its methodology in the development of clinical skills in the USA. This study aims to expand the established literature, demonstrating measurable improvement in the simulated performance of a complex clinical procedural skill by UK trainees. The environment can negatively impact on skill performance and we believe that simulation within the clinical environment is the key to improving skill levels in a meaningful way. This dramatically improves fidelity and provides the additional challenge of progressing from motor skill to psychomotor, whereby trainees must employ their newly-acquired non-technical skills to ensure technical success and patient safety. References McGaghie W, Issenberg SB, Barsuk JH, et al. A critical review of simulation-based mastery learning with translational outcomes. Med Educ 2014;48:375–385 Barsuk JH, Cohen ER, Caprio T, et al. Simulation-based education with mastery learning improves residents’ lumbar puncture skills. Neurology 2012;79:132–7 Wayne DB, Barsuk JH, O’Leary K, et al. Mastery learning of thoracentesis skills by internal medicine residents using simulation technology and deliberate practice. J Hosp Med 2008;3:48–54