Publications by authors named "Peter Jaye"

22 Publications

  • Page 1 of 1

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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http://dx.doi.org/10.1016/j.apergo.2019.102915DOI Listing
January 2020

Emergency Department Escalation in Theory and Practice: A Mixed-Methods Study Using a Model of Organizational Resilience.

Ann Emerg Med 2017 Nov 26;70(5):659-671. Epub 2017 Jun 26.

Kings College London, UK.

Study Objective: Escalation policies are used by emergency departments (EDs) when responding to an increase in demand (eg, a sudden inflow of patients) or a reduction in capacity (eg, a lack of beds to admit patients). The policies aim to maintain the ability to deliver patient care, without compromising safety, by modifying "normal" processes. The study objective is to examine escalation policies in theory and practice.

Methods: This was a mixed-method study involving a conceptual analysis of National Health Service escalation policies (n=12) and associated escalation actions (n=92), as well as a detailed ethnographic study of escalation in situ during a 16-month period in a large UK ED (n=30 observations).

Results: The conceptual analysis of National Health Service escalation policies found that their use requires the ability to dynamically reconfigure resources (staff and equipment), change work flow, and relocate patients. In practice, it was discovered that when the ED is under pressure, these prerequisites cannot always be attained. Instead, escalation processes were adapted to manage pressures informally. This adaptive need ("work as done") was found to be incompletely specified in policies ("work as imagined").

Conclusion: Formal escalation actions and their implementation in practice differed and varied in their effectiveness. Monitoring how escalation works in practice is essential in understanding whether and how escalation policies help to manage workload.
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http://dx.doi.org/10.1016/j.annemergmed.2017.04.032DOI Listing
November 2017

'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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http://dx.doi.org/10.1111/tct.12300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4497353PMC
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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http://dx.doi.org/10.1093/ageing/afv049DOI Listing
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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http://dx.doi.org/10.1136/bmjopen-2014-005472DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4298099PMC
January 2015

Full immersion simulation: validation of a distributed simulation environment for technical and non-technical skills training in Urology.

BJU Int 2015 Jul 7;116(1):156-62. Epub 2015 Mar 7.

Kings Health Partners, Guy's and St Thomas NHS Foundation Trust, London, UK.

Objective: To evaluate the face, content and construct validity of the distributed simulation (DS) environment for technical and non-technical skills training in endourology. To evaluate the educational impact of DS for urology training.

Subjects And Methods: DS offers a portable, low-cost simulated operating room environment that can be set up in any open space. A prospective mixed methods design using established validation methodology was conducted in this simulated environment with 10 experienced and 10 trainee urologists. All participants performed a simulated prostate resection in the DS environment. Outcome measures included surveys to evaluate the DS, as well as comparative analyses of experienced and trainee urologist's performance using real-time and 'blinded' video analysis and validated performance metrics. Non-parametric statistical methods were used to compare differences between groups.

Results: The DS environment demonstrated face, content and construct validity for both non-technical and technical skills. Kirkpatrick level 1 evidence for the educational impact of the DS environment was shown. Further studies are needed to evaluate the effect of simulated operating room training on real operating room performance.

Conclusions: This study has shown the validity of the DS environment for non-technical, as well as technical skills training. DS-based simulation appears to be a valuable addition to traditional classroom-based simulation training.
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http://dx.doi.org/10.1111/bju.12875DOI Listing
July 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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http://dx.doi.org/10.1111/tct.12156DOI Listing
August 2014

Face, content, and construct validation of the Bristol TURP trainer.

J Surg Educ 2014 Jul-Aug;71(4):500-5. Epub 2014 Apr 13.

Kings Health Partners, Guy's Kings and St Thomas' NHS Foundation Trust, London, United Kingdom.

Introduction: Validation studies are an important part of simulator evaluation and are considered necessary to establish the effectiveness of simulation-based training. The widely used Bristol transurethral resection of prostate (TURP) simulator has not been formally validated.

Objectives: Evaluation of the face, content, and construct validities of the Bristol TURP simulator as an endourology training tool.

Design: Using established validation methodology, face, content, and construct validities were evaluated. Face and content validities were assessed using a structured quantitative survey. Construct validity was assessed by comparing the performance of experts and novices using a validated performance scale and resection efficiency.

Participants And Setting: Overall, 8 novice urologists and 8 expert urologists participated in the study. The study was conducted in a dedicated surgical simulation training facility.

Results: All 16 participants felt the model was a good training tool and should be used as an essential part of urology training (face validity). Content validity evaluation showed that most aspects of the simulator were adequately realistic (mean Likert scores 3.38-3.57/5); however, the model does not simulate bleeding. Experts significantly outperformed novices (p < 0.001) across all measures of performance, therefore establishing construct validity.

Conclusions: The Bristol TURP simulator shows face, content, and construct validities, although some aspects of the simulator were not very realistic (e.g., bleeding). This study provides evidence for the continuing use of this simulator in endourology training.
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http://dx.doi.org/10.1016/j.jsurg.2014.01.013DOI Listing
April 2015

Cost and value in medical education.

Educ Prim Care 2013 Sep;24(6):391-3

Clinical Director, BMJ Learning.

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http://dx.doi.org/10.1080/14739879.2013.11494206DOI Listing
September 2013

Cost analyses approaches in medical education: there are no simple solutions.

Med Educ 2013 Oct;47(10):962-8

BMJ Learning, BMJ Publishing Group, London, UK.

Context: Medical education is expensive. Although we have made progress in working out 'what works' in medical education, there are few data on whether medical education offers value relative to cost. Research into cost and value in medical education is beset by problems. One of the major problems is the lack of clear definitions for many of the terms commonly used. Phrases such as cost-effectiveness analysis, cost-benefit analysis, cost-utility analysis and cost-feasibility analysis are used without authors explaining to readers what they mean (and sometimes without authors themselves understanding what they mean). Sometimes such terms are used interchangeably and sometimes they are used as rhetorical devices without any real evidence that backs up such rhetoric as to the cost-effectiveness or otherwise of educational interventions. The frequent misuse of these terms is surprising considering the importance of the topics under consideration and the need for precision in many aspects of medical education.

Methods: Here we define commonly used terms in cost analyses and give examples of their usage in the context of medical education.

Conclusions: Cost-effectiveness analysis refers to the evaluation of two or more alternative educational approaches or interventions according to their costs and their effects in producing a certain outcome. Cost-benefit analysis refers to 'the evaluation of alternatives according to their costs and benefits when each is measured in monetary terms'. Cost-utility analysis is the examination of two or more alternatives according to their cost and their utility. In this context, utility means the satisfaction among individuals as a result of one or more outcome or the perceived value of the expected outcomes to a particular constituency. Cost-feasibility analysis involves simply measuring the cost of a proposed intervention in order to decide whether it is feasible.
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http://dx.doi.org/10.1111/medu.12214DOI Listing
October 2013

How we developed an emergency psychiatry training course for new residents using principles of high-fidelity simulation.

Med Teach 2013 Oct 5;35(10):797-800. Epub 2013 Sep 5.

Central and North West London NHS Foundation Trust , UK.

New psychiatry residents must rapidly acquire new clinical skills and learn to work effectively with new colleagues. In medical and surgical specialties, high-fidelity simulation with structured debriefing is widely used, but so far this has not been applied to psychiatry. We have developed a one-day simulation-based training course for emergency psychiatry which incorporates clinical and team-working skills training. Five scenarios covering key psychiatric emergencies are delivered in a purpose-built simulation facility. Patients are played by an actor or a high-fidelity manikin. Each scenario is followed by a 45-minute group debrief. Evaluation of a pilot group found that the course was well received and improved participants' workplace confidence. We are now planning to expand the course, provide it to all new residents and conduct further evaluation.
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http://dx.doi.org/10.3109/0142159X.2013.803522DOI Listing
October 2013

Tablet based simulation provides a new solution to accessing laparoscopic skills training.

J Surg Educ 2013 Jan-Feb;70(1):161-3

Medical Research Council (MRC) Center for Transplantation, NIHR Biomedical Research Centre, Guy's Hospital, King's College London, King's Health Partners, London, United Kingdom.

Aim: Access to facilities that allow trainees to develop their laparoscopic skills is very limited in the hospital environment and courses can be very expensive. We set out to build an inexpensive yet effective trainer to allow laparoscopic skill acquisition in the home or classroom environment based on using a tablet as a replacement for the laparoscopic stack and camera.

Methods: The cavity in which to train was made from a cardboard box; we left the sides and back open to allow for natural light to fill the cavity. An iPad 2 (Apple Inc.) was placed over the box to act as our camera and monitor. We provided 10 experienced laparoscopic surgeons with the task of passing a suture needle through 3 hoops; then they filled in a questionnaire to assess Face (training capacity) and Content (performance) validity.

Results: On a 5-point Likert scale, the tablet-based laparoscopic trainer scored a mean 4.2 for training capacity (hand eye coordination, development, and maintenance of lap skills) and for performance (graphics, video, and lighting quality) it scored a mean 4.1.

Conclusions: The iPad 2-based laparoscopic trainer was successfully validated for training. It allows students and trainees to practice at their own pace and for inexpensive training on the go. Future "app-"based skills are planned.
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http://dx.doi.org/10.1016/j.jsurg.2012.08.008DOI Listing
August 2013

Simulation-based medical education: cost measurement must be comprehensive.

Surgery 2013 Feb 17;153(2):302. Epub 2012 Dec 17.

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http://dx.doi.org/10.1016/j.surg.2012.10.020DOI Listing
February 2013

Simulation training for improving the quality of care for older people: an independent evaluation of an innovative programme for inter-professional education.

BMJ Qual Saf 2013 Jun 6;22(6):495-505. Epub 2012 Dec 6.

Simulation and Interactive Learning (SaIL) Centre, St Thomas' Hospital, King's Health Partners, London, UK.

Introduction: This paper describes the evaluation of a 2-day simulation training programme for staff designed to improve teamwork and inpatient care and compassion in an older persons' unit.

Objective: The programme was designed to improve inpatient care for older people by using mixed modality simulation exercises to enhance teamwork and empathetic and compassionate care.

Methods: Healthcare professionals took part in: (a) a 1-day human patient simulation course with six scenarios and (b) a 1-day ward-based simulation course involving five 1-h exercises with integrated debriefing. A mixed methods evaluation included observations of the programme, precourse and postcourse confidence rating scales and follow-up interviews with staff at 7-9 weeks post-training.

Results: Observations showed enjoyment of the course but some anxiety and apprehension about the simulation environment. Staff self-confidence improved after human patient simulation (t=9; df=56; p<0.001) and ward-based exercises (t=9.3; df=76; p<0.001). Thematic analysis of interview data showed learning in teamwork and patient care. Participants thought that simulation had been beneficial for team practices such as calling for help and verbalising concerns and for improved interaction with patients. Areas to address in future include widening participation across multi-disciplinary teams, enhancing post-training support and exploring further which aspects of the programme enhance compassion and care of older persons.

Conclusions: The study demonstrated that simulation is an effective method for encouraging dignified care and compassion for older persons by teaching team skills and empathetic and sensitive communication with patients and relatives.
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http://dx.doi.org/10.1136/bmjqs-2012-000954DOI Listing
June 2013

The relationship between fidelity and cost in simulation.

Med Educ 2012 Dec;46(12):1226; author reply 1227

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http://dx.doi.org/10.1111/j.1365-2923.2012.04352.xDOI Listing
December 2012

Development and implementation of centralized simulation training: evaluation of feasibility, acceptability and construct validity.

BJU Int 2013 Mar 29;111(3):518-23. Epub 2012 Aug 29.

MRC Centre for Transplantation, King's College London, King's Health Partners, Department of Urology, Guy's Hospital, London, UK.

Unlabelled: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: A competent urologist should not only have effective technical skills, but also other attributes that would make him/her a complete surgeon. These include team-working, communication and decision-making skills. Although evidence for effectiveness of simulation exists for individual simulators, there is a paucity of evidence for utility and effectiveness of these simulators in training programmes that aims to combine technical and non-technical skills training. This article explains the process of development and validation of a centrally coordinated simulation program (Participants - South-East Region Specialist Registrars) under the umbrella of the British Association for Urological Surgeons (BAUS) and the London Deanery. This program incorporated training of both technical (synthetic, animal and virtual reality models) and non-technical skills (simulated operating theatres).

Objectives: To establish the feasibility and acceptability of a centralized, simulation-based training-programme. Simulation is increasingly establishing its role in urological training, with two areas that are relevant to urologists: (i) technical skills and (ii) non-technical skills.

Materials And Methods: For this London Deanery supported pilot Simulation and Technology enhanced Learning Initiative (STeLI) project, we developed a structured multimodal simulation training programme. The programme incorporated: (i) technical skills training using virtual-reality simulators (Uro-mentor and Perc-mentor [Symbionix, Cleveland, OH, USA], Procedicus MIST-Nephrectomy [Mentice, Gothenburg, Sweden] and SEP Robotic simulator [Sim Surgery, Oslo, Norway]); bench-top models (synthetic models for cystocopy, transurethral resection of the prostate, transurethral resection of bladder tumour, ureteroscopy); and a European (Aalborg, Denmark) wet-lab training facility; as well as (ii) non-technical skills/crisis resource management (CRM), using SimMan (Laerdal Medical Ltd, Orpington, UK) to teach team-working, decision-making and communication skills. The feasibility, acceptability and construct validity of these training modules were assessed using validated questionnaires, as well as global and procedure/task-specific rating scales.

Results: In total 33, three specialist registrars of different grades and five urological nurses participated in the present study. Construct-validity between junior and senior trainees was significant. Of the participants, 90% rated the training models as being realistic and easy to use. In total 95% of the participants recommended the use of simulation during surgical training, 95% approved the format of the teaching by the faculty and 90% rated the sessions as well organized. A significant number of trainees (60%) would like to have easy access to a simulation facility to allow more practice and enhancement of their skills.

Conclusions: A centralized simulation programme that provides training in both technical and non-technical skills is feasible. It is expected to improve the performance of future surgeons in a simulated environment and thus improve patient safety.
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http://dx.doi.org/10.1111/j.1464-410X.2012.11204.xDOI Listing
March 2013

Simulation training for hyperacute stroke unit nurses.

Br J Nurs 2011 Nov 24-Dec 7;20(21):1352-6

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

National clinical guidelines have emphasized the need to identify acute stroke as a clinical priority for early assessment and treatment of patients on hyperacute stroke units. Nurses working on hyperacute stroke units require stroke specialist training and development of competencies in dealing with neurological emergencies and working in multidisciplinary teams. Educational theory suggests that experiential learning with colleagues in real-life settings may provide transferable results to the workplace with improved performance. Simulation training has been shown to deliver situational training without compromising patient safety and has been shown to improve both technical and non-technical skills (McGaghie et al, 2010). This article describes the role that simulation training may play for nurses working on hyperacute stroke units explaining the modalities available and the educational potential. The article also outlines the development of a pilot course involving directly relevant clinical scenarios for hyperacute stroke unit patient care and assesses the benefits of simulation training for hyperacute stroke unit nurses, in terms of clinical performance and non-clinical abilities including leadership and communication.
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http://dx.doi.org/10.12968/bjon.2011.20.21.1352DOI Listing
February 2012

Face, content and construct validity of a virtual reality simulator for robotic surgery (SEP Robot).

Ann R Coll Surg Engl 2011 Mar;93(2):152-6

Urology Centre, uy’s Hospital, King’s College London, King’s Health Partners, London, UK.

Introduction: This study aims to establish face, content and construct validation of the SEP Robot (SimSurgery, Oslo, Norway) in order to determine its value as a training tool.

Subjects And Methods: The tasks used in the validation of this simulator were arrow manipulation and performing a surgeon's knot. Thirty participants (18 novices, 12 experts) completed the procedures.

Results: The simulator was able to differentiate between experts and novices in several respects. The novice group required more time to complete the tasks than the expert group, especially suturing. During the surgeon's knot exercise, experts significantly outperformed novices in maximum tightening stretch, instruments dropped, maximum winding stretch and tool collisions in addition to total task time. A trend was found towards the use of less force by the more experienced participants.

Conclusions: The SEP robotic simulator has demonstrated face, content and construct validity as a virtual reality simulator for robotic surgery. With steady increase in adoption of robotic surgery world-wide, this simulator may prove to be a valuable adjunct to clinical mentorship.
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http://dx.doi.org/10.1308/003588411X12851639108358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3293312PMC
March 2011

Optic disc assessment in the emergency department: a comparative study between the PanOptic and direct ophthalmoscopes.

Emerg Med J 2012 Dec 13;29(12):1007-8. Epub 2011 Oct 13.

Ophthalmology Department, Royal Free Hospital, Pond St, London NW3 2QG, UK.

Optic disc assessment is an essential part of the neurological examination of acutely unwell patients. This study compares the PanOptic ophthalmoscope with the direct ophthalmoscope for accuracy of diagnosis and ease of use. Patient satisfaction was also compared for the two instruments. A single-masked prospective observational study was carried out. The authors showed that the PanOptic ophthalmoscope was more sensitive (p=0.03) and specific (p=0.03) than the direct ophthalmoscope. The PanOptic ophthalmoscope was preferred by both doctors (p=0.001) and patients (p=0.04) in terms of comfort and ease of use.
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http://dx.doi.org/10.1136/emermed-2011-200038DOI Listing
December 2012

How to develop a simulation programme in urology.

BJU Int 2011 Dec 22;108(11):1698-702. Epub 2011 Aug 22.

MRC Centre for Transplantation, King's College London, King's Health Partners, Department of Urology, Guy's Hospital, UK.

What's known on the subject? and What does the study add? Inanimate trainers and simulators have been shown to facilitate the skill acquisition of urologists. However, there are significant challenges to integrating standalone simulation programmes into mainstream urology curricula. This study provides a framework to overcome these challenges and discusses the advantages of centralised urology simulation centres and their potential to serve as key adjuncts in the certification and validation process of urologists. Fixed performance-based outcomes of inanimate trainers and simulators have been praised as useful adjuncts in urology for reducing the learning curve associated with the acquisition of new technical and non-technical skills without compromising patient safety. Simulators are becoming an integral part of the urology training curriculum and their effectiveness is totally dependent on the structure of the programme implemented. The present paper discusses the fundamental concepts of centralized urology centres and their potential to serve as key adjuncts in the certification and validation process of urologists. In summary, proficiency-based curricula with well structured endpoints and objective tools for validating proficiency are critical in developing a simulation programme in urology. We concludes that more educational research into the outcomes of integrated urology curricula followed by trainee/trainer opinion surveys will help address some of these criteria.
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http://dx.doi.org/10.1111/j.1464-410X.2011.010420.xDOI Listing
December 2011

Individual care plans can reduce hospital admission rate for patients who frequently attend the emergency department.

Emerg Med J 2011 Aug 1;28(8):654-7. Epub 2010 Jun 1.

Emergency Department, Royal Alexandra Hospital, Paisley PA2 9PN, UK.

Aim: To investigate the impact, in terms of hospital admission and investigations, of individual care plans for patients who frequently attend the emergency department (ED).

Method: 32 patients who regularly attended the ED at St Thomas' Hospital were included in the study. After review of ED and hospital case records, an individual care plan was prepared for future attendances. The numbers of ED attendances, hospital admissions and investigations were collated from the electronic patient record system and compared for the 12 months prior to and 12 months after introduction of the care plan. Primary outcome measure was reduction in the number of hospital admissions (as a percentage of ED attendance). Secondary outcome measures were a reduction in the number of investigations and ED attendances.

Results: In the 12 months prior to introduction of the individual care plans, the 32 patients accounted for 858 ED attendances and 209 admissions to hospital. In 12 months after introduction of the care plans, the number of ED attendances fell to 517, with only 77 hospital admissions. Median number of hospital admissions (as a percentage of ED attendances) fell from 18.8% to 7.1% (p=0.014) after introduction of the care plan. There were also reductions in median number of ED attendances (19 vs. 5, p=0.001), median number of radiology tests (4 vs 1, p=0.001) and median number of blood tests (55 vs. 12, p<0.001).

Conclusions: Individual care plans for a carefully selected group of patients who frequently attend the emergency department can result in a decrease in the number of hospital admissions and number of investigations.
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http://dx.doi.org/10.1136/emj.2009.085704DOI Listing
August 2011
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