Publications by authors named "Gabriel Reedy"

17 Publications

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Communication skills in dietetic practice: a scoping review protocol.

JBI Evid Synth 2021 Jun 18. Epub 2021 Jun 18.

Department of Nutritional Sciences, King's College London, London, UK Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia Faculty of Life Science and Medicine, King's College London, London, UK.

Objective: This scoping review aims to examine and map the evidence regarding communication skills in dietetic practice, and the education strategies used to develop them. Specifically, the review will address usage in practice, perceptions and experiences, and teaching and assessment of communication skills in student dietitians and dietitians.

Introduction: Communication skills are a key element of practice for dietitians. Dietetic practice is evolving, and there is a need to explore the breadth of literature regarding communication skills for contemporary practice, and how they are taught.

Inclusion Criteria: This scoping review will consider empirical research that addresses dietitians' or nutritionists' communication skills. This will include skills used in dietitian-patient communication, in communication interactions in different employment contexts and diverse forms of communication (verbal, written, technological). We will consider the views of student dietitians, dietitians, and patients, and evidence regarding how communication skills are taught and assessed in dietetics. These may include experimental, quasi-experimental, observational, and qualitative studies.

Methods: The following electronic databases will be searched: MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), ERIC (EBSCO), and PsycINFO (Ovid) without time limits. Reference lists of eligible studies will be back-searched. Google Scholar will be used for forward citation tracking. Conference proceedings for the previous five years will be searched for eight conferences of the professional associations of dietetics and health care education. ProQuest Dissertations and Theses, and WorldCat Dissertations and Theses (OCLC) will be searched for unpublished literature. The findings will be summarized in tabular form and a narrative synthesis.
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June 2021

Success and limiting factors in health service innovation: a theory-generating mixed methods evaluation of UK projects.

BMJ Open 2021 05 25;11(5):e047943. Epub 2021 May 25.

Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK.

Objectives: To explore and explain success and limiting factors in UK health service innovation.

Design: Mixed methods evaluation of a series of health service innovations involving a survey and interviews, with theory-generating analysis.

Setting: The research explored innovations supported by one of the UK's Academic Health Science Networks which provides small grants, awards and structural support to health service innovators including clinical academics, health and social care professionals and third-sector organisations.

Participants: All recipients of funding or support 2014-2018 were invited to participate. We analysed survey responses relating to 56 innovation projects.

Results: Responses were used to conceptualise success along two axes: value creation for the intended beneficiaries and expansion beyond its original pilot. An analysis of variance between categories of success indicated that participation, motivation and evaluation were critical to value generation; organisational, educational and administrative support were critical to expansion; and leadership and collaborative expertise were critical to both value creation and expansion. Additional limiting factors derived from qualitative responses included difficulties navigating the boundaries and intersections between organisations, professions, sectors and cultures; a lack of support for innovation beyond the start-up phase; a lack of protected time; and staff burn-out and turnover.

Conclusions: A nested hierarchy of innovation needs has been derived via an analysis of these factors, providing targeted suggestions to enhance the success of future innovations.
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May 2021

Understanding adaptive teamwork in health care: Progress and future directions.

J Health Serv Res Policy 2021 Jul 16;26(3):208-214. Epub 2020 Dec 16.

Reader in Clinical Education, Faculty of Life Sciences and Medicine, King's College London, UK.

Health care teamwork is a vital part of clinical work and patient care but is poorly understood. Despite poor teamwork being cited as a major contributory factor to adverse events, we lack vital knowledge about how teamwork can be improved. Teams in health care are diverse in structure and purpose, and most patient care depends on the ability of different professionals to coordinate their actions. Research in this area has narrowly defined health care teams, focused mainly on a small range of settings and activities and addressed a limited range of research questions. We argue that a new approach to teamwork research is needed and make three recommendations. First, the temporal and dynamic features of teamwork should be studied to understand how teamwork unfolds sequentially. Second, contextual influences should be integrated into study designs, including the organization of work, tasks, patients, organisational structures, and health care system factors. Finally, exploratory, rather than confirmatory, research designs are needed to analyse the complex patterns of social interaction inherent in health care work, to build our theoretical understanding of health care teams and their work, and ultimately to develop effective interventions to support better teamwork for the benefit of patients.
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July 2021

The role of emergency preparedness exercises in the response to a mass casualty terrorist incident: A mixed methods study.

Int J Disaster Risk Reduct 2020 Jun;46:101503

Behavioural Science, Emergency Response Department Science & Technology, Public Health England, Porton Down, Salisbury, Wiltshire, SP4 0JG, UK.

Simulation exercises are an important part of emergency preparedness activities for the healthcare community but evidence of their impact on the response to real major incidents is limited. This project studied the impact of health emergency preparedness exercises (HEPEs) on the response to a mass casualty terrorist incident. The mixed methods study design was adopted comprising an on-line survey and follow up individual interviews. Participants were healthcare staff who took part in responses to three major terrorist incidents in the UK in 2017. Descriptive statistics and analysis of variance were undertaken with quantitative data. Content and thematic analysis methods were used for qualitative data analysis. The online survey generated 86 responses; 79 (92%) were from the responders to the Manchester Arena bombing. Twenty-one survey respondents shared their experiences in in-depth interviews. Healthcare staff who took part in HEPEs felt better prepared to respond than those who did not attend an exercise. The most commonly reported benefits from HEPEs were awareness of major incident plans and having the opportunity to practice responding to a similar scenario in the recent exercise. Specific benefits included: improved coordination of the response through adherence to recently practiced incident plans confidence with response roles; real-time modifications of the response and support provided to staff who did not take part in exercises. Exercise recency was highlighted as an important facilitating factor. The study provides strong objective evidence that the response to a mass casualty terrorist incident was enhanced by training and service development achieved through HEPEs.
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June 2020

UK healthcare staff experiences and perceptions of a mass casualty terrorist incident response: a mixed-methods study.

Emerg Med J 2020 Nov 11. Epub 2020 Nov 11.

Emergency Response Department, Science and Technology, Public Health England, Porton Down, UK.

Introduction: System learning from major incidents is a crucial element of improving preparedness for response to any future incidents. Sharing good practice and limitations stimulates further actions to improve preparedness and prevents duplicating mistakes.

Methods: This convergent parallel mixed methods study comprises data from responses to an online survey and individual interviews with healthcare staff who took part in the responses to three terrorist incidents in the UK in 2017 (Westminster Bridge attack, Manchester Arena Bombing and London Bridge attack) to understand limitations in the response and share good practices.

Results: The dedication of NHS staff, staff availability and effective team work were the most frequently mentioned enabling factors in the response. Effective coordination between teams and a functional major incident plan facilitated an effective response. Rapid access to blood products, by positioning the blood bank in the ED, treating children and parents together and sharing resources between trauma centres were recognised as very effective innovative practices. Recent health emergency preparedness exercises (HEPEs) were valued for preparing both Trusts and individual staff for the response. Challenges included communication between ambulance services and hospitals, difficulties with patient identification and tracking and managing the return to 'normal' work patterns post event. Lack of immediately available clinical protocols to deal with blast injuries was the most commonly mentioned clinical issue. The need for psychosocial support for responding and supporting staff was identified.

Discussion: Between-agencies communication and information sharing appear as the most common recurring problems in mass casualty incidents (MCIs). Recent HEPEs, which allowed teams, interdisciplinary groups, and different agencies to practice responding to similar simulated incidents, were important and informed actions during the real response. Immediate and delayed psychosocial support should be in place for healthcare staff responding to MCIs.
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November 2020

Along the Axes of Difference: Setting Scholarship and Practice Agendas for Faculty Development.

J Contin Educ Health Prof 2019 ;39(4):269-273

Dr. Reedy: Reader in Clinical Education, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom. Professor Bearman: Professor, Center for Research in Assessment and Digital Learning (CRADLE), Deakin University, Geelong, Australia.

The rise of academic clinical education programs underlines the growing influence of faculty development on how health care is taught and therefore practiced. Research to date has outlined the rapid rise of these postgraduate qualifications and their impact on their graduates' professional identities. Given the scale and nature of the change, it is worth considering these programs from a broader perspective. "Axes of difference" are invoked to chart the tensions and intersections between various social identities that form distinctive features of clinical education. Six axes are described: patients-clinicians, trainees-trainers, classrooms-clinics, uniprofessional-interprofessional, local-global, and teachers-clinicians. These reveal a range of complexities about faculty development, which can inform both practice and scholarship agendas.
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June 2020

An evidence based framework for the Temporal Observational Analysis of Teamwork in healthcare settings.

Appl Ergon 2020 Jan 15;82:102915. Epub 2019 Aug 15.

The Florence Nightingale Faculty of Nursing, Midwifery and PalliativeCare, King's College London, London, UK.

Objective: Effective teamwork is critical to patient safety across multiple healthcare settings. However, current observational tools assessing teamwork performance tend to be developed for specific settings or tasks and do not capture temporal features of interaction. This study aimed to develop a valid and reliable observational teamwork behaviour framework, which is based on healthcare practice, applicable across a variety of healthcare contexts and can be used to capture temporal team dynamics.

Methods: Team interactions were audio-visually recorded during routine simulation training at two large clinical education centres specialising in physical and mental healthcare. The framework was based on theoretical models of teamwork and was developed in three steps: 1-micro analysis of verbal and nonverbal behaviour during recorded scenarios (n = 20); 2-iterative test and refine cycles; 3-final behavioural framework applied to a cohort of acute emergency scenarios (n = 9) by two raters to assess inter-rater agreement.

Results: The framework contains twenty-three specific verbal and nonverbal behaviours that can be identified during observations. Behaviours are grouped conceptually based on their function resulting in thirteen behavioural functions, which cluster into five overarching teamwork domains. Inter-rater agreement was excellent (Cohen's Kappa = .84, SE = 0.03).

Conclusion: We present a valid and reliable behavioural framework, grounded in teamwork theory and empirical observations of clinical team behaviour. This framework enables analysis of the nuances and temporal features of clinical practice in depth and across a wide range of clinical contexts and settings. Use of this framework will advance our understanding of teamworking in healthcare.
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January 2020

Beyond the clinical team: evaluating the human factors-oriented training of non-clinical professionals working in healthcare contexts.

Adv Simul (Lond) 2019 13;4:11. Epub 2019 Jun 13.

2Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.

Background: As clinical simulation has evolved, it is increasingly used to educate staff who work in healthcare contexts (e.g. hospital administrators) or frequently encounter clinical populations as part of their work (e.g. police officers) but are not healthcare professionals. This is in recognition of the important role such individuals play in the patients' experience of healthcare, frequently being a patients' first point of contact with health services. The aim of the training is to improve the ability of the team to communicate and co-ordinate their actions, but there is no validated instrument to evaluate the human factors learning of non-clinical staff. Our aim was to develop, pilot and evaluate an adapted version of the Human Factors Skills for Healthcare Instrument, for non-clinical professionals.

Method: The 18-item instrument was developed reflecting the human factors skills of situation awareness, decision making, communication, teamwork, leadership, care and compassion and stress and fatigue management. The instrument was piloted pre- and post-training with non-healthcare professionals ( = 188) attending mental health simulation training within an 11-month period (June 2017-April 2018). Trainees were hospital/primary care administrators ( = 53, 28%), police officers ( = 112, 59%), probation officers ( = 13, 7%) and social workers ( = 10, 5%). Most participants were female ( = 110, 59%) and from White ethnic backgrounds ( = 144, 77%).

Results: Six items were removed, five were not sufficiently sensitive to change ( < .3) and one showed poor reliability. The remaining 12 items revealed a Cronbach's alpha of .93. An exploratory factor analysis revealed a one-factor solution, which explained 58.3% of the variance. The final 12-item instrument was sensitive to change post-training ( < .0001) with large effect sizes ( .7). Cluster analysis revealed that participants with lower pre-training scores showed the greatest improvement.

Discussion: The Human Factors Skills for Healthcare Instrument-Auxiliary version (HuFSHI-A) provides a reliable and valid instrument for the evaluation of human factors skills learning following training of non-clinical populations working in healthcare contexts. Although this instrument has been developed and evaluated with training courses specifically focusing on mental health topics, HuFSHI-A is applicable for any training where teamwork and co-ordination between clinical and non-clinical professionals is considered.
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June 2019

A scoping review of evaluation methods for health emergency preparedness exercises.

Am J Disaster Med Spring 2018;13(2):107-127

Leader, Behavioural Science Team, Emergency Response Department Science & Technology, Public Health England (PHE), Porton Down, UK.

Objective: To review and analyze evaluation methods currently utilized in health emergency preparedness exercises (HEPE).

Design: This study, part of a larger scoping review that systematically collected and reviewed published evidence related to the benefits of HEPE, provides a further analysis of the evaluation methods utilized in such exercises. We separately analyzed discussion-based and operation-based exercises according to their purpose. This addresses a methodological limitation related to the poorly understood relationship between the purpose and context in which a specific evaluation method is selected to be used.

Results: In the reviewed 64 studies, a variety of evaluation methods were utilized for HEPE including observations, participants' survey, and post-exercise debriefs. At present, the selection and use of these methods is not guided by any methodology, but seems rather arbitrary. No specific evaluation methods were isolated for any exercise type.

Conclusions: The purpose of evaluation should guide the selection of evaluation methods for HEPE, and these are not context specific. If evaluation is for accountability purposes, such as to test organizational capability to respond, participant feedback should be collected in addition to objective data on performance in an exercise. Advantages of routinely collecting data from exercise participants to study their reactions (exercise feedback, perceptions, satisfaction with the exercise) and routinely conducting post-exercise debriefs (both hot debrief and cold debrief), are discussed to support evaluation for development or learning purposes in any context.
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December 2018

MBRRACE in simulation: an evaluation of a multi-disciplinary simulation training for medical emergencies in obstetrics (MEmO).

J Obstet Gynaecol 2018 Aug 21;38(6):781-788. Epub 2018 Mar 21.

d Department of Women's Health, Guy's and St. Thomas' NHS Foundation Trust , London , UK.

The majority of maternal deaths in the UK are due to pre-existing or new-onset medical conditions, known as 'indirect deaths'. The MBRRACE report identified serious gaps in clinicians' human factors skills, including communication, leadership and teamwork, which contributed to maternal death. In response, we developed the first multi-disciplinary simulation-based training programme designed to address Medical Emergencies in Obstetrics (MEmO). Employing a mixed methods design, this study evaluated the educational impact of this training programme on the healthcare staff (n = 140), including the medical doctors (n = 91) and the midwives (n = 49). The training improved participants' clinical management of medical deterioration in pregnancy (p=.003) alongside improving their human factors skills (p=.004). Furthermore, participants reported the translation of these skills to their routine clinical practice. This flexible training is responsive to the changing national needs and contextualises the MBRRACE findings for healthcare staff. It is a promising avenue for reducing the rates of in-direct death in pregnancy. Impact statement What is already known on this subject? The majority of maternal deaths in the UK are due to pre-existing or new-onset medical conditions. The management of medical conditions in pregnancy relies on a multi-professional approach. However, serious gaps in clinicians' human factors skills, highlighted by the MBRRACE report, may contribute to maternal death. What do the results of this study add? This study evaluated the first multi-disciplinary, simulation-based training programme designed to address Medical Emergencies in Obstetrics (MEmO). Training significantly improved participants' management of medical deterioration in pregnancy and human factors skills, particularly in the areas of leadership, communication and teamwork. Moreover, the participants learning translated into their clinical practice. What are the implications of these findings for clinical practice and/or further research? The delivery of multi-disciplinary team training for all healthcare staff involved in the complex management of medical conditions in pregnancy can help develop a greater understanding of others' professional roles, and demonstrate the importance of interprofessional teamwork. Furthermore, it provides the space to reflect on team working approaches, including the leadership and professional autonomy, and their potential impact on patient care. Future research should evaluate the impact of this training on the objective outcome measures of medical emergencies in pregnancy.
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August 2018

Development of the Human Factors Skills for Healthcare Instrument: a valid and reliable tool for assessing interprofessional learning across healthcare practice settings.

BMJ Simul Technol Enhanc Learn 2017 Oct 21;3(4):135-141. Epub 2017 Jun 21.

The Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK.

Background: A central feature of clinical simulation training is human factors skills, providing staff with the social and cognitive skills to cope with demanding clinical situations. Although these skills are critical to safe patient care, assessing their learning is challenging. This study aimed to develop, pilot and evaluate a valid and reliable structured instrument to assess human factors skills, which can be used pre- and post-simulation training, and is relevant across a range of healthcare professions.

Method: Through consultation with a multi-professional expert group, we developed and piloted a 39-item survey with 272 healthcare professionals attending training courses across two large simulation centres in London, one specialising in acute care and one in mental health, both serving healthcare professionals working across acute and community settings. Following psychometric evaluation, the final 12-item instrument was evaluated with a second sample of 711 trainees.

Results: Exploratory factor analysis revealed a 12-item, one-factor solution with good internal consistency (α=0.92). The instrument had discriminant validity, with newly qualified trainees scoring significantly lower than experienced trainees ((98)=4.88, p<0.001) and was sensitive to change following training in acute and mental health settings, across professional groups (p<0.001). Confirmatory factor analysis revealed an adequate model fit (RMSEA=0.066).

Conclusion: The Human Factors Skills for Healthcare Instrument provides a reliable and valid method of assessing trainees' human factors skills self-efficacy across acute and mental health settings. This instrument has the potential to improve the assessment and evaluation of human factors skills learning in both uniprofessional and interprofessional clinical simulation training.
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October 2017

Post graduate clinical placements: evaluating benefits and challenges with a mixed methods cross sectional design.

BMC Med Educ 2016 Feb 16;16:64. Epub 2016 Feb 16.

King's Learning Institute, King's College London, Waterloo, London, UK.

Background: Systematic evaluations of clinical placements are rare, especially when offered alongside academic postgraduate courses. An evidence-based approach is important to allow pedagogically-driven provision, rather than that solely governed by opinion or market demand. Our evaluation assessed a voluntary clinical placement scheme allied to a mental health course.

Methods: Data were collected over academic years 2010/11- 2013/14, from participating students (n = 20 to 58) and clinician supervisors (n = 10-12), using a mixed-methods cross-sectional design. Quantitative evaluation captured information on uptake, dropout, resource use, attitudes and experience, using standardized (the Placement Evaluation Questionnaire; the Scale To Assess the Therapeutic Relationship - Clinical version and the University of Toronto Placement Supervisor Evaluation) and bespoke questionnaires and audit data. Qualitative evaluation comprised two focus groups (5 clinicians, 5 students), to investigate attitudes, experience, perceived benefits, disadvantages and desired future developments. Data were analysed using framework analysis to identify a priori and emergent themes.

Results: High uptake (around 70 placements per annum), low dropout (2-3 students per annum; 5 %) and positive focus group comments suggested placements successfully provided added value and catered sufficiently to student demand. Students' responses confirmed that placements met expectations and the perception of benefit remained after completion with 70 % (n = 14) reporting an overall positive experience, 75 % (n = 15) reporting a pleasant learning experience, 60 % (n = 12) feeling that their clinical skills were enhanced and 85 % (n = 17) believing that it would benefit other students. Placements contributed the equivalent of seven full time unskilled posts per annum to local health care services. While qualitative data revealed perceived 'mutual benefit' for both students and clinicians, this was qualified by the inherent limitations of students' time and expertise. Areas for development included fostering learning around professionalism and students' confidence on placement.

Conclusions: The addition of healthcare placements to academic postgraduate taught courses can improve their attractiveness to applicants, benefit healthcare services and enhance students' perception of their learning experiences. Well-positioned and supported placement learning opportunities could become a key differentiator for academic courses, over potential competitors. However, the actual implications for student employability and achievement remain to be established.
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February 2016

'The Diamond': a structure for simulation debrief.

Clin Teach 2015 Jun;12(3):171-5

King's Learning Institute, King's College London, UK.

Background: Despite debriefing being found to be the most important element in providing effective learning in simulation-based medical education reviews, there are only a few examples in the literature to help guide a debriefer. The diamond debriefing method is based on the technique of description, analysis and application, along with aspects of the advocacy-inquiry approach and of debriefing with good judgement. It is specifically designed to allow an exploration of the non-technical aspects of a simulated scenario.

Context: The debrief diamond, a structured visual reminder of the debrief process, was developed through teaching simulation debriefing to hundreds of faculty members over several years. The diamond shape visually represents the idealised process of a debrief: opening out a facilitated discussion about the scenario, before bringing the learning back into sharp focus with specific learning points. Debriefing is the most important element in providing effective learning in simulation-based medical education reviews

Innovation: The Diamond is a two-sided prompt sheet: the first contains the scaffolding, with a series of specifically constructed questions for each phase of the debrief; the second lays out the theory behind the questions and the process.

Implication: The Diamond encourages a standardised approach to high-quality debriefing on non-technical skills. Feedback from learners and from debriefing faculty members has indicated that the Diamond is useful and valuable as a debriefing tool, benefiting both participants and faculty members. It can be used by junior and senior faculty members debriefing in pairs, allowing the junior faculty member to conduct the description phase, while the more experienced faculty member leads the later and more challenging phases. The Diamond gives an easy but pedagogically sound structure to follow and specific prompts to use in the moment.
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June 2015

Evaluation of a simulation training programme for geriatric medicine.

Age Ageing 2015 Jul 6;44(4):677-82. Epub 2015 May 6.

Department of Ageing and Health, Guy's and St Thomas' Hospital, Westminster Bridge Road, London, UK.

Background: geriatrics encompasses diverse medical, social and ethical challenges requiring a multidimensional, interdisciplinary approach. Recent reports have highlighted failings in the care of older people. It is therefore vital that trainees in geriatrics are afforded opportunities to develop skills in managing this complex population. Simulation has been adopted as a teaching tool in medicine; however, evidence for its use in geriatrics has been limited to small, single-site studies primarily involving role-play or discrete clinical skills training.

Methods: a standardised, two centre, multimodal, interprofessional, geriatrics simulation training programme was developed using curriculum-mapped scenarios in which the patient perspective was central. Simulation techniques used included high-fidelity patient manikins, actors with integrated clinical skills using part-task trainers and role-play exercises. A mixed-methods evaluation was used to analyse data from participants before and after training.

Results: eighty-nine candidates attended 12 similar courses over 2 years. Thematic analysis of candidate feedback was supportive of simulation as a useful tool, with benefits for both technical and non-technical skills. Candidates commented that simulation was a valuable training modality addressing curriculum areas rarely taught formally including continence assessment, end-of-life decisions and multidisciplinary situations. Quantitative analysis of pre- and post-course questionnaires revealed a significant improvement of self-reported confidence in managing geriatric scenarios (mean improvement 11.5%; P < 0.001).

Discussion: this study demonstrated the feasibility of a standardised simulation training programme across two sites in geriatrics. Simulation training affords situational learning without compromising patient safety and is an exciting and novel method of delivering teaching for geriatrics that could be integrated into national training curricula.
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July 2015

Does interprofessional simulation increase self-efficacy: a comparative study.

BMJ Open 2015 Jan 13;5(1):e005472. Epub 2015 Jan 13.

Simulation and Interactive Learning (SaIL) Centre at St Thomas House, Kings Health Partners, London, UK.

Objectives: In this work, we have compared uniprofessional and interprofessional versions of a simulation education intervention, in an attempt to understand more about whether it improves trainees' self-efficacy.

Background: Interprofessionalism has been climbing the healthcare agenda for over 50 years. Simulation education attempts to create an environment for healthcare professionals to learn, without potential safety risks for patients. Integrating simulation and interprofessional education can provide benefits to individual learners.

Setting: The intervention took place in a high-fidelity simulation facility located on the campus of a large urban hospital. The centre provides educational activities for an Academic Health Sciences Centre. Approximately 2500 staff are trained at the centre each year.

Participants: One hundred and fifteen nurses and midwives along with 156 doctors, all within the early years of their postgraduate experience participated. All were included on the basis of their ongoing postgraduate education.

Methods: Each course was a one-day simulation course incorporating five clinical and one communication scenarios. After each a facilitated debriefing took place. A mixed methods approach utilised precourse and postcourse questionnaires measuring self-efficacy in managing emergency situations, communication, teamwork and leadership.

Results: Thematic analysis of qualitative data showed improvements in communication/teamwork and leadership, for doctors and nurses undergoing simulation training. These findings were confirmed by statistical analysis showing that confidence ratings improved in nurses and doctors overall (p<0.001). Improved outcomes from baseline were observed for interprofessional versus uniprofessional trained nurses (n=115; p<0.001). Postcourse ratings for doctors showed that interprofessional training was significantly associated with better final outcomes for a communication/teamwork dimension (n=156; p<0.05).

Conclusions: This study provides evidence that simulation training enhances participants' self-efficacy in clinical situations. It also leads to increases in their perceived abilities relating to communication/teamwork and leadership/management of clinical scenarios. Interprofessional training showed increased positive effects on self-efficacy for nurses and doctors.
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January 2015

Simulation training for geriatric medicine.

Clin Teach 2014 Aug;11(5):387-92

Department of Ageing & Health, St Thomas' Hospital, London, UK.

Background: Geriatric medicine encompasses a diverse nature of medical, social and ethical challenges, and requires a multidimensional, interdisciplinary approach. Recent reports have highlighted failings in the care of the elderly, and it is therefore vital that specialist trainees in geriatric medicine are afforded opportunities to develop their skills in managing this complex patient population. Simulation has been widely adopted as a teaching tool in medicine; however, its use in geriatric medicine to date has involved primarily role-play or discrete clinical skills training. This article outlines the development of a bespoke, multimodal, simulation course for specialist trainees in geriatric medicine.

Methods: A 1-day multimodal and interprofessional simulation course was created specifically for specialist trainees in geriatric medicine, using six curriculum-mapped scenarios in which the patient perspective was central to the teaching objectives. Various simulation techniques were used, including high-fidelity human patient manikins, patient actors, with integrated clinical skills using part-task trainers, and role-play exercises. Debriefs by trained faculty members were completed after each scenario.

Results: Twenty-six candidates attended four similar courses in 2012. Quantitative analysis of pre- and post-course questionnaires revealed an improvement of self-reported confidence in managing geriatric scenarios (Z = 4.1; p < 0.001), and thematic analysis of candidate feedback was supportive of simulation as a useful teaching tool, with reported benefits for both technical and non-technical skills.

Discussion: Simulation is an exciting and novel method of delivering teaching for specialist trainees in geriatric medicine. This teaching modality could be integrated into the training curriculum for geriatric medicine, to allow a wider application.
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August 2014

Using the mind as a simulator: a randomized controlled trial of mental training.

J Surg Educ 2013 Jul-Aug;70(4):544-51

King's College London, London, UK.

Objectives: Laparoscopic simulators have been introduced as safe and effective methods of developing basic skills. Mental training is a novel training method likened to using the mind as a simulator to mentally rehearse the movements of a task or operation. It is widely used by professional athletes and musicians and has been suggested as a technique that could be used by surgical trainees. The purpose of this study was to assess the use of mental training in developing basic laparoscopic skills in novices.

Methods: Sixty-four medical students without laparoscopic experience were randomized into 4 groups. The first 3 groups were trained to cut a circle on a box trainer. Group 1 received no additional training (BT), Group 2 received additional virtual reality training (BT + VRS), and Group 3 received additional mental training (BT + MT). The fourth group was trained on a virtual reality simulator with additional mental training (box-free). The following 4 assessment criterias: time, accuracy, precision and overall performance were measured on both the box-trainer and virtual simulator.

Results: The mental training group (BT + MT) demonstrated improved laparoscopic skills over both assessments. The improvement in skills in the VRS group (BT + VRS) was limited to VRS assessment and not observed in the box assessment. The fourth group (box-free) had the worst performance on both methods of assessment.

Conclusion: The addition of mental training led to improved laparoscopic skills development. It is a flexible technique and has the potential to challenge VRS as a more cost-effective training method associated with lower capital investment. Given the benefits of mental training with further research, it could be considered for inclusion in training curricula.
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February 2014