Suzanne Gough

Innovations in interprofessional learning and teaching: providing opportunities to embed patient safety within the pre-registration physiotherapy curriculum. A Pilot Study

Abstract Background: Despite recognition of the need to embed patient safety within undergraduate healthcare education, there are limited examples of how this has been achieved within physiotherapy. The purpose of this regional initiative was to develop a course and teaching resources to support Higher Education Institutions in the United Kingdom (UK) when embedding the World Health Organization (WHO) multiprofessional patient safety curriculum into undergraduate healthcare education. Objectives: In this pilot study, researchers assessed the impact of the interprofessional simulation-based education (IPSE) course on students’ perceptions of interprofessional learning and patient safety post-course, and explored the participants’ perceived application of knowledge and skills 3 months later. Methods: A sequential mixed-methods evaluation was conducted, including pre- and post-course Readiness for Interprofessional Learning Scale (RIPLS) questionnaires and two course evaluation questionnaires featuring open and closed items (administered immediately post-course and 3 months later). Participants included undergraduate physiotherapy, medical, nursing, and pharmacy students. Results: The IPSE course enabled students to develop an appreciation of each other’s professional roles and particularly their individual and collaborative practices that may positively impact upon patient safety. Post-course students reported being able to influence patient safety through an increased application of their ability to identify errors and influence their colleagues’ practices, thus impacting directly upon patient safety. Conclusion: This paper provides an evaluation of an innovative method of providing interprofessional patient safety learning and teaching opportunities within undergraduate healthcare curricula.

Using video-reflexive ethnography and simulation-based education to explore patient management and error recognition by pre-registration physiotherapists

BackgroundUpon graduation, physiotherapists are required to manage clinical caseloads involving deteriorating patients with complex conditions. In particular, emergency on-call physiotherapists are required to provide respiratory/cardio-respiratory/cardiothoracic physiotherapy, out of normal working hours, without senior physiotherapist support. To optimise patient safety, physiotherapists are required to function within complex clinical environments, drawing on their knowledge and skills (technical and non-technical), maintaining situational awareness and filtering unwanted stimuli from the environment. Prior to this study, the extent to which final-year physiotherapy students were able to manage an acutely deteriorating patient in a simulation context and recognise errors in their own practice was unknown.MethodsA focused video-reflexive ethnography study was undertaken to explore behaviours, error recognition abilities and personal experiences of 21 final-year (pre-registration) physiotherapy students from one higher education institution. Social constructivism and complexity theoretical perspectives informed the methodological design of the study. Video and thematic analysis of 12 simulation scenarios and video-reflexive interviews were undertaken.ResultsParticipants worked within the professional standards of physiotherapy practice expected of entry-level physiotherapists. Students reflected appropriate responses to their own and others’ actions in the midst of uncertainty of the situation and physiological disturbances that unfolded during the scenario. However, they demonstrated a limited independent ability to recognise errors. Latent errors, active failures, error-producing factors and a series of effective defences to mitigate errors were identified through video analysis. Perceived influential factors affecting student performance within the scenario were attributed to aspects of academic and placement learning and the completion of a voluntary acute illness management course. The perceived value of the simulation scenario was enhanced by the opportunity to review their own simulation video with realism afforded by the scenario design.ConclusionsThis study presents a unique insight into the experiences, skills, attitudes, behaviours and error recognition abilities of pre-registration physiotherapy students managing an acutely deteriorating patient in a simulation context. Findings of this research provide valuable insights to inform future research regarding physiotherapy practice, integration of educational methods to augment patient safety awareness and participant-led innovations in safe healthcare practice.

Simulation-based education (SBE) within postgraduate emergency on-call physiotherapy in the United Kingdom

BACKGROUND The application and extent of simulation-based education use within cardiorespiratory physiotherapy postgraduate education (in-house/regional provisions) and emergency oncall services were previously unexplored. OBJECTIVES This survey aimed to investigate the extent to which simulation-based education is currently utilised by physiotherapy services in the UK. DESIGN A national postal questionnaire-based survey. SETTING All 280 National Health Service Critical/Intensive Care Units in England, Northern Ireland, Scotland and Wales, providing emergency on-call physiotherapy services were included in the survey. PARTICIPANTS Emergency on-call physiotherapy service leads. METHOD A self-administered 20-item postal questionnaire survey was designed to establish the extent to which simulation-based education was currently being used within cardio-respiratory physiotherapy post-registration training. RESULTS A useable response rate of 55% (155/280) was achieved, representing a range of respiratory and emergency on-call service leads. Sixty-one Trusts (39%) currently use simulation within acute respiratory or emergency on-call postgraduate training. The provision of simulation equipment varied with respect to type, fidelity and accessible to the physiotherapy service. Simulation-based education featured in emergency on-call induction, updates, competency assessment, assessment skills, treatment skills and scenarios (75, 92, 39, 28, 82, 48% respectively). CONCLUSIONS Simulation is currently used to teach a wide variety of cardio-respiratory physiotherapy skills relevant to the acute respiratory and on-call environments. Adoption was dependent upon local facilities, needs and training requirements. National inconsistencies in availability, fidelity and accessibility were identified. The evidence base surrounding the current use of simulation-based education within physiotherapy is limited and evidence of transferability to the practice arena remains relatively unknown. Future research is warranted to determine the education outcomes, impact on skill performance, competency, retention and patient safety when integrating SBE within EOC training activities.

O2 Cost consequence analysis of simulation-based education and video-reflexivity in pre-registration physiotherapy

Background Limited health economic costs analysis has been published in relation to the use of simulation-based education (SBE) in healthcare. Whilst two research studies have previously reported the cost of delivering simulation scenarios within a physiotherapy research study, both omitted full economic costs (FEC) associated with SBE design and delivery.1,2 To date, the cost analysis of combining SBE and video-reflexive ethnography (VRE) in pre-registration physiotherapy is unreported. Methodology Cost consequence analysis has been undertaken in relation to phase 2 of a pragmatic mixed methods study of the use of SBE in cardio-respiratory physiotherapy in the UK. Phase 2 featured the use of SBE and VRE to explore performance, behaviours and personal experiences of final year pre-registration physiotherapy students.3 The transparent approach to costing (TRAC) was used to calculate FEC of 12 scenarios and respective video-reflexive interviews (debriefs). Results The value attributed by participants included an opportunity to promote skills development, increase self-awareness, placement preparation and the potential to influence patient safety.3 Whereas, the cost analysis of providing this intervention was £3706 per 24 learners, equating to £154.42 per learner. Alternatively, streaming the scenario to an entire cohort reduces costs per learner to £31.10 (saving £123.32 per learner). The cost consequence analysis related to SBE design and delivery, equity of provision, capital investment costs and associated faculty training costs. Conclusion and recommendations Further experimental studies will be required to demonstrate the value of combining different mediums, modalities and methods of SBE with VRE before comprehensive health economic evaluations relating to impact on learning outcomes and academic performance, transfer to practice and healthcare can be established. Future research will help to ascertain the value and the associated costs to inform decisions of the efficacy, viability and sustainability of SBE in physiotherapy. References Black B, Marcoux B. Feasibility of using standardized patients in a physical therapist education program: a pilot study. J Phys Ther. 2002;16:49–56. Shoemaker M, Beasley J, Cooper M, Perkins R, Smith J, Swank C. A method for providing high-volume interprofessional simulation encounters in physical and occupational therapy education programs. J Allied Health. 2011;40:15–21. Gough S, Yohannes A, Murray J. Using video-reflexive ethnography and simulation-based education to explore patient management and error recognition by pre-registration physiotherapists. Adv Simulation. 2016;1:1–16.

0074 Development of a new framework to support simulation based education (SBE) for midwifery skills and drills

Background Within clinical practice it was identified there was no framework available to guide the design and implementation of simulation-based education (SBE) in midwifery. Simulation frameworks within healthcare exist,1,2 however these frameworks lacked direct application to midwifery skills and drills. This has led to the design of a new framework which is currently being utilised and evaluated. Results The new framework is subdivided into key components with a specific focus on the role of the facilitator, candidate prior knowledge, and the design and evaluation of the pre-brief, SBE and debrief. Facilitator preparation prior to simulation design is essential to identify potential boundaries that may affect candidate learning.1,3 Recognition of candidate pre-existing knowledge and ensuring psychological safety is essential and will help create the optimal learning environment. Ensuring pedagogical principles are understood and applied methodically for the design and implementation of SBE will help facilitate effective learning.4 Effective pre-brief must be incorporated within SBE to allow candidates to understand learning objectives and expectations. Feedback/debriefing has been identified as one of the most essential components within SBE3,5,6 and is a distinctive component within the framework. It was observed within practice prior to the new framework being applied that existing debrief practices at the Trust were unstructured and ineffective. Through application of the proposed framework, improvements in debriefing have been achieved. Potential impact The proposed framework was designed to support maternity services with the design, implementation and evaluation of SBE for skills and drills. It is anticipated that it will help to improve knowledge and awareness and help bridge the gap between theory and practice.7 The proposed framework identifies the importance of ensuring the learning objectives match the curriculum and have educational benefit.3,5 Further development of the framework is required and will occur following evaluation from SBE within midwifery skills and drills. References Jefferies PR. A framework for designing, implementing, and evaluating simulations. Nurs Educ Perspect. 2005;26(2):97–104 Chiniara G, Cole G, Brisbin K, Huffman D, Cragg B, Lamacchi M, Norman D. Canadian network for simulation in healthcare guidelines working group. Simulation in healthcare: a taxonomy and a conceptual framework for institutional design and media selection. Med Teach. 2013;35:1380–1395 MotolaI, Devine LA, Chung HS, Sullivan JE, Issenberg B. Simulation in healthcare education: a best evidence practical guide. AMEE Guide No. 82. Med Teach. 2005;35:1511–1530

0022 Introducing a regional simulated patient train-the-trainer programme and simulated patient common framework

Background Simulated Patients (SP) are volunteers, actors or people trained to portray the role of a patient or relative in healthcare education.1 This project has developed, piloted and evaluated a bespoke Simulated Patient Train-The-Trainer programme (SP3T) for Simulation Trainers in the North West of England. Methodology A sequential exploratory mixed methods design was selected to provide comprehensive analysis of the SP3T programme. Results Firstly, the evidence base was explored to develop a regional questionnaire-based survey. A regional survey was undertaken with 89 responses received from participants working within 24 different organisations (including 4 HEIs, 20 NHS Trusts and 31 separate departments). The findings from a review of the evidence and survey were used to develop the bespoke standardised, evidence-based SP3T programme. The programme consists of a pre-requisite e-learning course and interactive workshop. Eighteen SP Trainers have completed the e-learning and workshop programme as well as the post-workshop and impact evaluations. Feedback from the 18 participants (from 16 different organisations across the North West of England) and 5 SPs has been incorporated to further develop the SP3T course resources and ‘Simulated Patient Common Framework’.2 Conclusions The overall aim of improving knowledge, awareness and best practice in relation to incorporating SPs within simulation-based education (SBE) or workforce development training programmes in the region has been achieved through a regional survey and four different evaluations of the pilot SP3T programme. The Simulated Patient Common Framework provides a reference point to guide the involvement of SPs within healthcare education. The Simulated Patient Common Framework and associated SP3T programme was designed to empower simulation trainers to effectively work with SPs in education and training, and ultimately lead to improvements in patient safety. It is anticipated that this programme will encourage simulation trainers to maximise the potential of embedding SPs in their practice. References Nestel D, Bearman M. Chapter 1: Introduction to simulated patient methodology. In: Nestel D, Bearman M, eds. Simulated patient methodology: theory, evidence and practice. West Sussex: Wiley Blackwell, 2015: 1–4 Gough S, Greene L, Nestel D, Hellaby M, MacKinnon R, Natali A, Roberts S, Tuttle N, Webster B. Simulated patients: a standardised, quality assured approach to training and implementation. Final Project Report. Manchester: Health Education North West, 2015

0061 Can using simulation improve graduate physiotherapists’ clinical reasoning (measured by the critical thinking in respiratory questionnaire) and improve on-call competency?

Background On-call physiotherapy is a duty expected of all qualified physiotherapists. It is important to ensure that on-call physiotherapists are appropriately trained. It is hypothesised that simulation may be a suitable method for training post-graduate staff for on-call duties, even if respiratory is not their chosen speciality. This project is designed to evaluate the effectiveness of simulation for developing clinical reasoning, and to address the real world challenge of how to train staff and maintain competency for working in respiratory care. Methodology: mixed methods approach A pre-post design will be used to evaluate the impact of simulation training on clinical reasoning, self-efficacy, self-confidence, and competency. Video-ethnography featuring triangulation of skills, behaviours and clinical reasoning. Participants will attend a day of simulation training and be video-recorded assessing and treating simulated patients. The participants’ self-perception of their clinical reasoning and competency for on-call will be measured using the ‘Critical Thinking in Respiratory Care’ instrument (CTRC);1 secondly with the ‘ACPRC on-call clinical competency questionnaire’2 before and immediately after the training. The participants’ perception of the effect of the simulation training will be measured immediately post-simulation via the ‘Simulation User’s Evaluation Questionnaire’.3 The CTRC and the ACPRC questionnaires will be repeated at 6 months after the training. Analysis Means and standard deviations will be analysed for all outcome measures.1–3 The primary analysis will be a paired t-test of pre and immediate post-training CTRC scores to evaluate the effect of training on clinical reasoning. Participants’ skills, behaviours and clinical reasoning will be compared to the scenario learning outcomes developed by expert physiotherapists and respiratory academics and triangulated with the video data to determine the effect of training. Potential impact It is anticipated that training using simulation will improve the self-confidence and self-efficacy of on-call physiotherapists alongside performance improvements. References Goodfellow LT, Valentine T, Holt ME. Construction and validation of an instrument to assess critical thinking in respiratory care: an empirical process. Respir Care Educ J 1999;8:13–26 Thomas S, Gough S, Broad MA, Cross J, Harden B, Ritson P, et al. On call competence: developing a tool for self-assessment. Physiotherapy 2008;94:204–211 Levett Jones T, McCoy M, Lapkin S, Noble D, Hoffman K, Dempsey J, Arthur C, Roche J. The development and psychometric testing of the satisfaction with simulation experience scale. Nurse Educ Today 2011;31(7):705–710

0075 ‘Train-rehearse-think-repeat’, helping algorithms work: In-situ theatre team training on a budget

Background Although simulation is an effective learning tool that improves patient safety,1 the space, time and resources to achieve additional training for theatre staff are at a premium. Algorithms are routinely used to support patient safety in healthcare but the opportunity to learn them is rare.2 This presentation will provide insights into how the combination of in-situ team training (on a budget) was developed to improve patient safety in theatres. Methodology To facilitate improvements in the use of common algorithms in both paediatric and adult theatres, a simulation innovation was developed to allow the multi-disciplinary team (MDT) to train and rehearse ‘high risk, low frequency’ (HRLF) events together.3 This innovation generated the possibility to allow MDT teams to practice rare (HRLF) events in-situ. This innovation was developed with minimal funding and utilised theatre space when not in use. Intervention ‘Train’: Related to the standard MDT training (e.g. basic and advanced life support). ‘Rehearse’: The MDT were given the opportunity to rehearse rare HRLF events using in-situ simulation. ‘Think’: Following simulation, all MDT members participated in a detailed debrief. ‘Repeat’: Post-debrief, participants had the opportunity to repeat elements of the simulation to galvanise new learning. A further opportunity for participants to repeat the scenario is provided six months later, to demonstrate retention of skills and knowledge. Results/outcomes Initial evaluations will be presented including, cost analysis, simulation facilitator observations, participant feedback and impact. Key findings include changes in participant’s technical and non-technical skills, improved understanding and use of algorithms. Potential impact Initial findings indicate that this low cost in-situ simulation innovation improves the use of algorithms in theatre. By augmenting emergency algorithms and mandatory life support training, MDT members are able to ‘train, rehearse, think and repeat’: learning together in-situ to build resilience and confidence amidst the unpredictability of theatre practice. References Department of Health. A framework for technology enhanced learning. London: Department of Health, 2011 Von Der Heyden M, Meissner K. Simulation in preclinical emergency medicine. Best Pract Res Clin Anaesthesiol 2015;29(1):61–68 Chiniara G, Cole G, Brisbin K, Huffman D, Cragg B, Lamacchia M, Norman D. Simulation in healthcare: a taxonomy and conceptual framework for instructional design and media selection. Med Teach 2013;35(8):1380–1395

0020 The development of a new ‘integrated simulation-based education framework’

Background A literature review failed to identify a framework to facilitate the instructional design of SBE in physiotherapy. Instructional design models,1 technology enhanced learning2 and nursing simulation3 frameworks have previously been used to guide the development of some healthcare SBE initiatives.1–4 Methodology A sequential, two phased explanatory mixed methods was study selected to provide a comprehensive examination of the use of simulated learning in cardio-respiratory physiotherapy in the UK. Phase 1 consisted of two national surveys during 2009–10. Phase 2 featured the use of video-reflexive ethnography (VRE)to explore performance, behaviours and personal experiences of final year (pre-registration) physiotherapy students. A new conceptual ‘integrated simulated learning framework’, was developed from phase 2 methodological design, VRE analysis and educational and SBE pedagogy. Results The new framework consists of 3 distinct but interlinking, essential components to be considered when designing, developing and evaluating SBE including: ‘preparation’, ‘intervention’ and ‘evaluation/research’. The ‘preparation’ component includes three constituent elements: learner, facilitator and educational practices. Intervention: The ‘intervention’ component features three separate elements: the ‘simulation design characteristics’, ‘pre-brief and debrief’ and ‘linked learning activities’. ‘Evaluation/research’: It is essential that an evaluation of the simulated learning intervention is undertaken to evaluate effectiveness/assess learning outcomes.1,2,3 Evaluation should be undertaken to explore the impact of learning from SBE through to practice. Following evaluation, information may then be analysed, and actioned accordingly within curriculum/programme/course review. Conclusion This framework presents 3 major interlinking components for consideration when designing SBE, whether this be for a short course or embedded within healthcare curricular. One of the key additions of the proposed framework was to illustrate that evaluation and research cyclically drive changes in SBE. The new framework is proposed to support the instructional design of SBE in healthcare. Further testing of this framework is required in physiotherapy and other healthcare disciplines. References Chiniara G, Cole G, Brisbin K, Huffman D, Cragg B, Lamacchi M, Norman D. and Canadian Network for Simulation in Healthcare Guidelines Working Group. Simulation in healthcare: a taxonomy and a conceptual framework for institutional design and media selection. Med Teach. 2013:35:1380–1395 Department of Health. A framework for technology enhanced learning. London: Department of Health, Crown Copyright, 2011 Jeffries PR. A framework for designing, implementing, and evaluating simulations. Nurs Educ Perspect. 2005:26:97–104 Ravert P, McAfooes J. NLN/Jeffries simulation framework: State of the science summary. Clin Simulation Nurs. 2014;8:410–411