Summer 2015 SEAUK newsletter - The Society for Education in Anaesthesia … ·...

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SUMMER 2015

NEWSLETTER

SOCIETY FOR EDUCATION IN ANAESTHESIA

EDITOR’S NOTE

Welcome to the summer edition of the SEA UK Newsletter. This year we held our ASM in Birmingham. It was an interesting day, focusing on the more challenging elements of education such as teaching professionalism, handling difficult conversations and the ethics of supervision. For those of you who were unable to attend, the Society’s council members have kindly put together a detailed review of the presentations, workshops and plenary sessions (pages 3-‐7). As always, we are delighted to publish articles submitted by our members. In this edition, on page 14, Dr Gallie summarises her experience of creating a combined healthcare and fire service human factors training day. It encourages us to consider the possibilities of expanding our training beyond healthcare. On page 11, we are delighted to have received an insightful account of a trainee who was successfully awarded a travel grant from the Society in 2014. Dr Moore travelled to Uganda. Her visit focused on obstetric anaesthesia and was undertaken in collaboration with the Liverpool-‐Mulago Partnership (LMP). Claire Joannides

CONTENTS

PRESIDENT’S REPORT 2 SEA UK ASM 2015 3 ASM FREE PAPER WINNERS 8 ASM POSTER PRESENTATION WINNER 10 TRAVEL GRANT REPORT 2015 11 TRAINING REVIEW: A COMBINED HEALTHCARE FIRE SERVICE HUMAN FACTORS TRAINING DAY 12 USING A GOODWILL RESOURCE TO INTEGRATE FORMATIVE ASSESSMENTS WITH FACULTY DEVELOPMENT 14 NEW COUNCIL APPOINTMENTS 15 SEAUK ASM 2016 ADVERT 16

SEA UK Newsletter Summer 2015

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PRESIDENT’S REPORT Dear Colleague Summer is upon us although as I look out of my office window at the rain I have my doubts. Firstly I would like to welcome our new council members, Nimmi Souderarajan and Alistair Burns (trainee rep, taking over from Claire Joannides). I am delighted that Claire has decided to stay on to complete her term now she is a consultant and will continue to produce this newsletter. Michelle Denton has taken over from Kim Russon as secretary and I would like to welcome her to her new role and give my grateful thanks to Kim for all her very hard work for the society as secretary. We are currently looking to appoint 2 new council members to keep us at full strength as members demit in October this year. Since the last newsletter, we have held our Annual Scientific meeting in Birmingham. It was a good meeting although attendance from members was lower than usual. I would like to thank Cindy Persad (especially as she managed to do it all while on maternity leave) and Yogita Chikermane for all their hard work in organising the day for us. We had some high quality abstract presentations and posters, the winners of which are published in this newsletter. Next year we will have the ASM at the Royal College of Anaesthetists on Monday March 7th. This hopefully will have some collaboration with SEA in the USA with which we are forming links. The meeting will explore language in education including the contribution of technology and innovations in technology. We continue to collaborate with the college in various areas of education and training. Most specifically we are contributing three articles to the Bulletin in March, July and November, so look out for them. We are collaborating with the Anaesthetist as Educator group to run an update in educational supervision in October at the college. As a Society we contribute, through our council members, to the NIAA (Rob McCahon), CPD board at the College (Teresa Dorman), the Specialist Society meeting, AAGBI (last one Chris Leng) and the Anaesthetist as Educator group, RCOA ( Teresa, Alison Cooper, Laurence Boss, Sharon Drake, to name but a few!). The GMC has closed its consultation on the review of standards for education and training and a new standards document will be published in July. I would urge you to contribute to these consultations and to feedback to the college and the GMC regarding education and training. There are thousands of anaesthetists contributing to education and training in the NHS every day and we should have a voice, but we will only have a voice if we all speak up and tell them what we think! Finally, as always I would ask for your feedback. Have you got ideas for articles or research we can help you with? Would you like to contribute to our activities? What else can we do for you as a member? Let us know. Email Cath at [email protected]. Have a great summer and hopefully see you at the 2016 ASM in London

Teresa Dorman, President SEA


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SEA UK ASM 2015 MARCH 2015 BIRMINGHAM

WRITTEN BY SEA UK COUNCIL MEMBERS

The City of Birmingham was host to the SEA ASM 2015. This year’s theme was: ‘Delivering Quality Education in Anaesthesia in today’s NHS’.

There were a few hiccups with the audio-‐visual support at the start of the day but this was quickly remedied and delegates were treated to an informative and well-‐presented day. The first speaker was Dr Nigel Penfold, former President of the Royal College of Anaesthetists. Dr Penfold updated the audience on the developing trends in anaesthetic training likely to affect us in the coming year. He talked about curriculum review, exams review, peri-‐operative medicine and workforce issues. It is likely that the ‘shape of training’ review will govern the future changes in medical education. The delegates then broke up for the morning workshop session.

Trainee free paper presentations followed. This year’s presenters were well versed on a wide range of topics; from simulation based training to training programmes in Zambia.

The judges had a difficult decision to make but in the end Dr. Rory Colhoun was deemed to be the winner with Dr. Stephen Hillier as the runner up. Both abstracts are published later in this newsletter along with the winner of the poster presentation-‐ Dr Elizabeth Huddlestone.

Presentation winners

‘What does good quality education look like?’ was our second key note presentation. Dr Seema Quasim, Consultant Anaesthetist at University Hospital Coventry provided us with a whistle stop tour of what quality in medical education looks like and how we can best demonstrate quality in our teaching and training by using the guidance from the Academy of Medical Educators and General Medical Council. The Academy of Medical Educators (AoME) lists 5 core values of medical educators:

• Designing and planning learning • Teaching and facilitating learning • Assessment of learning • Educational Research and Scholarship • Educational Management and Leadership

For each domain, there are level 2 and level 3 examples. So for ‘Teaching and facilitating learning’ to achieve standard 2 the effective supervisor should use a broad range of educational methods and technologies but to achieve level 3 – Fellowship, the excellent supervisor would also be expected to be adaptive and innovative in using and developing educational methods and technologies. Likewise, the General Medical Council (GMC) has developed a comprehensive framework of standards that uses seven areas set out by the Academy of Medical Educators to enable LETBs to demonstrate how they identify, train and appraise trainers (Academy of Medical Educators (2010: A Framework for the Professional Development of Postgraduate Medical Supervisors):


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• Ensuring safe and effective patient care through training

• Establishing and maintaining an environment for learning

• Teaching and facilitating learning • Enhancing learning through assessment • Supporting and monitoring educational

progress • Guiding personal and professional

development • Continuing professional development as

an educator Taking the first domain – ‘Ensuring safe and effective patient care through training’, Dr Quasim illustrated ways in which to demonstrate this such as using educational interventions to enhance patient care, involving trainees in service improvement and involving patients as educators. After this informative talk, delegates were treated to a pleasant lunch at the restaurant. ‘How to teach professionalism’ was the topic presented by Bryn Baxendale in the first afternoon session. He started by defining professionalism: Relationship within a community; standing; and sharing knowledge and skills. We are increasingly challenged with revolution in knowledge and standing in society. Where do medical professionals sit in society and how does society view us and our standing in society. There are many more conflicts on how we are perceived with professionalism than previous decades. Characteristics of professionalism:

• Driven by a sense of vocation and purpose.

• There is now more of a political stance (on the place of the doctor).

• Altruism (patient welfare) • Autonomy (empowering) • Social justice • Responsible and accountable

There are many stimuli or external forces such as the Bristol Paediatric enquiry, Harold Shipman, Mid-‐Staffs etc. that drive the standards set for us as professionals.

What is involved in developing professionalism?

1. Curriculum targets • Behaviours, skills, knowledge

2. Workplace practice • Organisation learning • Leadership and team performance • Individual capability

Dr Baxendale’s entertaining talk was followed by the afternoon workshop sessions and poster judging. This year’s winning poster ‘Organising In-‐situ Simulation: One Trainee’s Description of a Valuable Learning Opportunity’ was presented by Dr Elizabeth Huddlestone. Her abstract is also published later in this newsletter. Our final presenter for the day, Dr Ian Curran, spoke about ‘Competence, proficiency or capability, the debate goes on’. Dr Ian Curran is a well know figure within education and is now working for the GMC. He took us on a whistlestop tour of the roles of the GMC: Quality assurance, medical schools , curriculum, programmes and registration and support of doctors. He explored the definition of professionalism and the changes with the medicine as a high risk industry and how this compares with a high reliability industry. He believes there is a clinical and political case for change. The NPSA reported 8 million safety incidents in 2005. We should aspire for Excellence. Ian explained a number of models / concepts supporting professional excellence; the Curve; Layers; the Triangle; the Polygon; the Parabola. Ultimately, we should never value teaching over learning. It is not about the method but the impact.

Dr Ian Curran


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The day ended with a sincere thank you from SEA President, Teresa Dorman. SEA continues to work with other education groups to promote high standards in training in anaesthesia. The next ASM will be hosted in London and promises to be just as informative and good value for already stretched study budgets.

Council members and Harry Walmsley

PLENARY SESSIONS

The first Plenary of the ASM was on ‘Trainers in difficulty’. At the outset, the speaker, Dr. Spencer established her credibility by explaining that she had been the past chair of NACT and that she had led on the NACT UK document ‘Managing Trainees in Difficulty’. Next she emphasized the difference between the terms ‘trainer’ and ‘Trainer’.

The term ‘trainer’ refers to any doctor who supervises and supports the trainee/learner in the workplace whereas the term ‘Trainer’ (with a capital T) is an individual with a specific role that requires additional training e.g. educational supervisor or a clinical supervisor.

The plenary was run in a workshop style. In groups of three, we were requested to discuss the reasons why a ‘Trainer ‘might land up in difficulty. The participants came up with the following points:

1. Bullying behaviour 2. Behaviour perceived as sexual

harassment 3. Discriminatory behaviour 4. Other stresses e.g. family, anxiety of

managing their of own clinical practice for occasional lists

5. Inexperience – clinical or educational 6. Culture within the organisation

7. Lack of awareness of expectations 8. Lack of awareness of the

curriculum/assessment tools 9. Personality clash with the learner 10. Lack of communication 11. Fear of being accused 12. Lack of ‘Feedback’ skills

Dr. Spencer added that sexual harassment by Trainers was surprisingly common and that many female trainees tolerated this behaviour in the interest of their careers. She also pointed out that the ‘College tutor (CT)’ within the defined area is the designated person to ensure the ‘right’ learning environment and that ‘Trainers in difficulty’ should be reported to the appropriate college tutors. She also suggested that, at induction, the CTs should allocate named educational and clinical supervisors for the each trainee. They should also clearly signpost the person who can be approached if they have a problem with their ‘Trainers’. She reiterated that all doctors have a duty of candour not just to patients but also to colleagues and that we all have a duty to reflect and reply to comments about how we are perceived by our colleagues.

Next, the participants were divided into three groups to discuss how to manage the ‘Trainer’ in the following situations:

1. How they would deal with a Trainer who is reported for bullying behaviour?

2. How they would handle a Trainer who is reported as ‘NOT clinically competent’

3. How they would tackle a Trainer who is ‘NOT doing his job’

Dr. Spencer expertly summarised the discussion by making the following points:

1. In Scenario 1, it is important to clarify, verify and explore the context and the trainer’s version of events. It is important to triangulate and check if the trainee’s complaint is a disguise for poor performance. It is important to be fair, have a non-‐judgmental approach and to be neutral till we have the facts.

2. In Scenario 2, it may be a patient safety issue and it would be prudent to involve the clinical director.


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3. In Scenario 3, it would be important to provide support and development opportunities. It would help if ‘Trainers’ are recognised and given time for training in their job plans.

Dr. Spencer then discussed how the problem could be prevented. At this point, the usefulness of referring to Maslow’s hierarchy of needs was emphasized. Dr. Spencer also reiterated that the college tutors should be spending time with ‘Trainers’ – guiding and supporting them to fulfil their educational roles. The need for a ‘Trainer feedback tool’ was highlighted and reference was made to the article written by Dr. Norris in the CSQ-‐Bulletin_88. Dr. Spencer also described the concept of a ‘local faculty group (LFG)’. Together, the college tutor, the local faculty group and the training programme director make up the support system for ‘Trainers’.

Finally, Dr. Spencer concluded by saying that a good Trainer is one who will support the trainee by walking hand in hand with them through the training process.

The second Plenary of the ASM was entitled ‘The learning environment’ and presented by Dr. Cyprian Mendonca, an educator with a special interest in ‘airway’ training.

The session objectives were outlined as:

1. What is learning? 2. What is an ideal learning environment? 3. How to create and how to evaluate the

learning environment?

The definition of learning was clarified and then the participants were requested to provide examples of what we teach and how. Dr. Mendonca provided details about the teaching of skills. He added that his experience in airway training had contributed greatly to his understanding of ‘skills training’. The analogy of ‘driving’ was used to stress the importance of learning ‘laryngoscopy’ and ‘fibreoptic intubation’ in a non-‐clinical environment such as the ‘skills lab’.

Dr. Mendonca then defined the learning environment as the ‘diverse physical locations and contexts in which students learn’ and allowed the participants to explore their own

understanding of the factors which influence the learning environment. In groups of four, we discussed the differences between a pleasant and an unpleasant learning experience.

The factors influencing the learning environment were then summarised as:

1. Relationship between the teacher and learner

2. Teaching methods (e.g. supportive vs. humiliating)

3. Resources vs. pressures (with an emphasis on ‘time’ for training)

4. Trainers and standards of teaching 5. Trainee characteristics (e.g. prior

knowledge, motivation, learning styles) 6. Resources (e.g equipment, teaching aids,

space etc)

A detailed discussion of the learning environment then followed. ‘Maslow’s hierarchy of needs’ was referred to and the importance of ensuring that the ‘set’ was appropriate was emphasized. The importance of considering factors such as group size, classroom set up, equipment e.g. simulators, planning of sessions and inclusion of breaks was highlighted. Dr. Mendonca described the ‘Coventry airway lab sessions’ and showed pictures of their learning environment to illustrate the details. The challenges of ‘in theatre’ teaching were then discussed and summarised as:

1. Physical space 2. Pressure on the trainee (of being

watched) 3. Ensuring patient safety 4. Provision of time for learning 5. Availability of equipment 6. Ensuring trainer’s own skills and

confidence 7. Distracting the surgeon 8. Planning and balancing learning

opportunity in a multi-‐professional environment including:

a. Setting objectives b. Role delegation c. Acknowledgement of the

presence of all learners in the theatre and involving them in the


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learning e.g. medical students and students nurses and ODP students

d. Declaration of the ‘teaching plan’ at the safety brief

e. Learning conversation at the ‘debrief’

The participants and the speaker emphasized the importance of ‘training lists’ and acknowledged that many learning opportunities are possibly being missed. The value of virtual learning environments for acquisition of psychomotor skills was highlighted. Dr. Mendonca spoke about the usefulness of the ORSIM simulator for ‘Fibreoptic skills’ training and virtual reality based simulators for regional anaesthesia training. The discussion then moved to evaluation of the learning environment. Dr. Mendonca referred to Kirkpatrick’s model for evaluation of training programmes and then spoke of the various validated inventories which could be used for the evaluation of the educational environments – DREEM (Dundee Ready Education Environment Measure) for the undergraduate environment, ATEEM (Anaesthetic Theatre Educational Environment Measure) for the theatre environment and PHEEM (Post Graduate Hospital Education Environment Measure) for the intensive care environment. He referred to the original article on the ‘Development and validation of the Anaesthetic Theatre Educational Environment Measure’ by Holt and Roff which was published in ‘The Medical Teacher’ in 2004.

The plenary was particularly relevant in the light of the GMC consultation on the new standards for the future of medical education and training. The proposed first theme for the standards is focussed on the ‘Learning environment and culture’. The statement ‘Education and training should be a valued part of the culture, so that learners have a good experience and trainers are valued’ is central to this theme and to ensuring patient safety for the future. This plenary made us think actively about enhancing the learning environment within our workplace. One of the workshops during the day was on the topic of ‘Handling Difficult Conversations in Education’ presented by Dr Gearoid Fitzgerald. Dr Fitzgerald is a Consultant Psychiatrist. He quickly put the workshop members at ease by sharing some of his own experiences of difficult conversations in an open, honest and relaxed manner and engaged the group to share their own experiences. The hour passed quickly and my take home message was that you may not find a solution during a difficult conversation and that’s ok.

Dr Gearoid Fitzgerald’s workshop


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SEA UK ASM FREE PAPER WINNERS MARCH 2015 BIRMINGHAM

FIRST PRIZE SAFE OBSTETRICS COURSE: EDUCATION AIMED AT REDUCING MATERNAL MORTALITY IN ZAMBIA RORY COLHOUN1, PHIL BONNETT2, DAVID SNELL3 1 SPECIALTY DOCTOR ANAESTHESIA, ROTHERHAM NHS FOUNDATION TRUST, UK 2 CONSULTANT ANAESTHETIST, SHEFFIELD HOSPITALS NHS TRUST, SHEFFIELD, UK 3 CONSULTANT ANAESTHETIST, UNIVERSITY TEACHING HOSPITALS, ZAMBIA Maternal mortality in Zambia remains unacceptably high at 280 per 100,000 live births1. Despite significant progress there is still work to be done to reduce maternal mortality in line with the World Health Organisation’s (WHO) Millennium Development Goals. In an effort to reduce mortality through education, we have developed a programme to deliver the Lifebox and the AAGBI’s SAFE (Safe Anaesthesia From Education) obstetric anaesthesia courses to all anaesthetic providers within Zambia. To date we have run two courses and have two further courses planned for 2015. METHOD Zambian and UK-‐based clinicians formed a joint faculty to deliver the courses. The one-‐day Lifebox course promotes the WHO Surgical Checklist and emphasises the importance of pulse oximeter monitoring. The three-‐day SAFE obstetric anaesthesia course aims to improve the safety of obstetric anaesthetic care provision and employs lectures, simulation and workshops to deliver teaching. Participants were asked to complete a pre-‐course and post-‐course Multiple Choice Question (MCQ) test and a simulated scenario test. Pre and post-‐course test scores were analysed using paired students t-‐test for statistical significance. RESULTS 64 Zambian anaesthetic providers attended the combined Lifebox/SAFE obstetrics anaesthesia course in two locations. The participants were a mixture of physicians and specialist nurses. The scores of all participants improved following education with statistically significant improvement in all test areas (P <0.001).

DISCUSSION We have demonstrated that the courses delivered are effective in improving skills and knowledge of the participants who attend. Our long-‐term aim is to establish a sustainable programme of anaesthetic courses, delivered by Zambian clinicians, to run on a twice-‐yearly basis. Funding for this has been secured from the Zambian Ministry of Health. It is hoped that widespread training amongst anaesthetic providers will help to reduce maternal mortality attributable to anaesthetic causes. REFERENCES

1) WHO http://www.who.int/gho/maternal_health/countries/en/index.html

0

50

100

LIFEBOX-‐ MCQ

SAFE -‐ MCQ SAFE -‐ SKILLS

PERC

ENTA

GE (%

) PRE-‐COURSE AVERAGE POST-‐COURSE AVERAGE


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RUNNER UP The ideal trainer; what do anaesthetic trainees think is most important? STEPHEN HILLIER1, VISHAL DHOKIA2, 1 ST5 ANAESTHESIA, UNIVERSITY HOSPITALS LEICESTER, UK AND 2CLINICAL FELLOW IN SIMULATION AND HUMAN FACTORS, NORTHAMPTON GENERAL HOSPITAL, UK A large proportion of anaesthesia education takes place in the operating theatre environment. The approach of the trainer can significantly influence the quality of this learning and consultant feedback systems are emerging [1]. This study explores specific behaviours identified by trainees as impacting significantly on the quality of their learning.

METHODS A questionnaire was distributed to trainees of all grades from novice to ST7+. Trainees were asked to think of a consultant they consider an excellent trainer in theatre and list the attributes on which they base this. Answers were given as free text of unlimited length. They were then asked to identify a poor trainer and list attributes in the same way. Results were collated using Microsoft Excel and underwent content analysis; as themes emerged they were indexed into categories and sub-‐categories. RESULTS Responses were received from 8 CT1-‐2, 15 ST3-‐4, 9 ST5+: 102 for 'excellent' and 98 for 'poor’ trainers. Table 1 identifies attributes of an ‘excellent’ trainer. For excellent trainers: CT1-‐2 often reported allowing trainees to attempt procedures without interference, ST3-‐4 reported receiving explanations and completing WPBAs; ST5+ reported the processes of explaining to, discussing with and challenging the trainee. For poor trainers: CT1-‐2 reported a negative attitude e.g. being patronising, ST3-‐4 reported issues from two poles of not allowing trainee to do procedures or at being ‘abandoned’ for service provision. ST5+ reported lack of consideration of trainees’ views. DISCUSSION The most common attributes relate to issues such as attitude, communication, role allocation and style of supervision. The trainees at all levels identified the desire for further discussions about the decision making process, clear instructions and explanations. These provide insights into priorities for trainees in theatre.

Theme Details

Attitude (30) Enthusiastic to teaching in particular

Atmosphere (30) Friendly and supportive

Communication (27) Explains options and thought process

Role allocation (27) Clear about roles and responsibility

Competence (12) Technical ability of teacher

Theme Details

Feedback (19) Debriefs regularly; feedback and explanations

Supervision style (11) Ability to stand back

Planning (9) Asks trainees requirements

Assessments (7) Completing formal assessments

Opportunity (4) To perform practical procedures

Teaching (2) Exam based teaching

References 1. Norris A, Presland A. Trainee feedback for consultants: time to take our own medicine? ROCA Bulletin Nov 2014;88:p66 2. Arah OA, Hoekstra JB, Bos AP, Lombarts KM. New tools for systematic evaluation of teaching qualities of medical faculty: results of an ongoing

multi-‐centre survey. PLOS ONE 2011;6:e25983


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SEA UK ASM POSTER WINNER Organising In-‐situ Simulation: One Trainee’s Description of a Valuable Learning Opportunity DR E HUDDLESTONE1 AND DR S MERCER2 1ST7 ANAESTHESIA, LIVERPOOL WOMEN’S HOSPITAL, UK AND 2CONSULTANT ANAESTHETIST AND MEDICAL DIRECTOR FOR THE CENTRE FOR SIMULATION AND PATIENT SAFETY, NHS NORTH WEST. The Royal College of Anaesthetist’s Advanced Curriculum1 describes 6 domains; Clinical Practice, Team Working, Leadership, Innovation, Management and Education. By arranging an ‘in situ simulation’2 project during my Advanced Obstetric training unit I was able to develop these areas and demonstrate additional acquired skills mapped to the Curriculum. METHODS With support from the Centre for Simulation and Patient Safety3, we designed an in situ simulation scenario for post-‐partum haemorrhage based around the current hospital guidelines. Permission was granted by the Medical Director, Head of Midwifery and the Research and Ethics Department. . We ran the scenario ‘live’ with no additional staff, in order to truly test the system. RESULTS Although running an ‘in situ’ simulation should have been relatively straight forward, there were many obstacles to implementation and these allowed demonstration of competencies that could be translated into workplace based assessments. These included negotiation with senior management, dealing with potential cancellation and explaining to and convincing staff on the benefits of this exercise. DISCUSSION Simulation ‘in situ’ has been described as an excellent means of detecting latent errors4. Although we discovered several and rectified them, this project allowed demonstration of several of the mature attributes that are required to function as a consultant. Recommendations to trainees considering implementing similar projects include:

1. Choosing a project that they are passionate about as it may be hard work ‘to get others on board’. 2. Leave plenty of time to organise the project as approval, including that from the R&D department,

may take months. 3. Start with a simple scenario for which there are already clear guidelines. 4. Be persistent. Don’t take no for an answer but be nice about it. Choose a supportive mentor to

whom you are accountable so you don’t give up when it gets hard. REFERENCES 1 Royal College of Anaesthetists. CCT in Anaesthetics, Annexe E-‐ Advanced Level Training. Available from:

http://www.rcoa.ac.uk/system/files/TRG-‐CCT-‐ANNEXE_0.pdf. Downloaded 28/11/2014. 2 Mercer SJ, Wimlett S. Simulation in situ. Bulletin of the Royal College of Anaesthetists 2012; 76: 28-‐30 3 Centre for Simulation and Patient Safety NHS England. www.simulationandpatientsafety.com (accessed 2 December 2014) 4 Wheeler, Derek S., et al. High-‐reliability emergency response teams in the hospital: improving quality and safety using in situ simulation

training. BMJ Quality & Safety 2013; 22: 507-‐514


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Travel Grant Report HOIMA, UGANDA DR J MOORE ST6 ANAESTHETIST, NHS GRAMPIAN UNDERTAKEN IN COLLABORATION WITH THE LIVERPOOL MULAGO PARTNERSHIP

Thank you to SEA UK for supporting this recent visit to Uganda in October 2014. The visit was focused around obstetric anaesthesia and was undertaken in collaboration with the Liverpool-‐Mulago Partnership (LMP). This partnership was formed in 2008 and has now expanded activity and focus to improving several healthcare centres in Uganda. It is now part of the Ugandan Maternal and Newborn Hub, a network of 8 Ugandan obstetric healthcare partnerships. The focus of the LMP is to reduce maternal and infant mortality and improve the quality of obstetric and neonatal healthcare through exchange of knowledge and training of local staff

I travelled to Hoima in Uganda in October this year. Hoima is a small town in the West of Uganda served by the Hoima Regional Referral Hospital (HRRH), a hospital with 246 beds and two operating theatres. The hospital is a regional referral centre serving Hoima, Kibaale, Buliisa, Kiryandongo and Masindi districts. Its catchment area is around three million people. In addition, there are a high number of immigrants and refugees from the neighbouring Democratic Republic of Congo. Only around 45% of staff vacancies are filled and Hoima has only 1 doctor per 38,917 people, less than the national average of 1 per 24,725, while WHO recommends 1 per 800. The hospital is

government funded and drugs and medical supplies are in short supply. There is a limited laboratory service and electricity and water supplies are erratic. There is no recovery room. The hospital has specialists in obstetrics, paediatrics, medicine, ophthalmology and surgery. The maternal mortality rate in Uganda is 440 per 100,000. HRRH has a maternity unit with a labour ward, postnatal ward and a theatre with two operating tables. Obstetric anaesthesia is provided by three anaesthesia practitioners, none of whom have medical training. Only one of these is usually present at any one time and they frequently care for more than one patient simultaneously. I joined a volunteer UK obstetrician based in Hoima and worked with this obstetrician, local obstetricians, residents and anaesthesia providers in the maternity unit. In addition, I participated in a local educational meeting the focus of which was effective handover, and both a maternal mortality and paediatric mortality meeting. During the first week there were also a group of paediatricians and midwifery staff from the Basingstoke Hoima partnership for Health (BHPH) present whom I was also able to work with. Although my time in Hoima was short, this was an extremely busy maternity unit and I was able to be involved in numerous cases and a variety of obstetric emergencies including managing severe pre-‐eclampsia and major haemorrhage with limited supplies and available monitoring or equipment. One day we had three cases of uterine rupture to manage


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simultaneously! Anaesthesia equipment varied from draw-‐over vaporisers with ether to a glostavent and halothane and I learned first-‐hand of the profound bradycardias associated with halothane use. One theatre was equipped with a more sophisticated anaesthetic machine although use of this was limited by the erratic electricity supply. I also became involved in a slightly different line of work when I learnt the dual role of the anaesthesia provider in neonatal resuscitation! I also spent a day at the Azur Christian clinic located in Hoima, a private not-‐for-‐profit hospital in Hoima run by the ‘Help Hoima’ charity, with its own theatre although unfortunately this was not functioning due to a problem with the anaesthetic machine. This was causing problems when managing obstetric emergencies at the clinic as patients required transfer across town to HRRH or anaesthesia providers were called to attend but there would be delays in awaiting their arrival if cases were ongoing in HRRH, and they were then limited in anaesthesia provision due to the faulty machine. I spent a rather interesting day attempting to restore the function of the machine which involved effectively taking the machine apart and putting it back together again and did manage to locate the cause of the problem – a missing cable. The next few hours were then spent locating the correct cable for purchase but despite our best efforts, alas we were unable to restore the machine to working order. My time in Hoima was short lived but one which I will remember. I was humbled by the experience and impressed with the knowledge and abilities of the staff who welcomed me and with whom I worked closely, and whilst I hope they were able to learn from me during my time there, I most certainly learnt a great deal from them.

Training Review: A combined healthcare fire service human factors training day DR H GALLIE, CONSULTANT ANAESTHETIST, SALFORD ROYAL HOSPITAL NHS FT SIMON HAMILTON, WATCH MANAGER MANCHESTER AIRPORT FIRE SERVICE, MANCHESTER AIRPORT GROUP Human Factors is gaining recognition within healthcare as an important part of medical training. High reliability organisations such as Navy aircraft carriers, NASA, nuclear power and aviation have embraced Human Factors concepts. These organisations take every opportunity to learn through investigation of critical incidents and near misses1,2,3. They also promote the distribution of learning between industries1,2,3. I decided to explore this by developing a study day for theatre staff and fire service personnel. The programme used a range of teaching methods including short talks, lectures, individual tasks, group work, discussion and facilitation. Various media were employed such as videos, power point, diagrams and illustrations. Sessions presenting new knowledge and definitions were covered by short lectures, others such as communication utilised a combination of individual and group tasks. Human factors theories and strategies to reduce error were presented throughout the day. The case discussions required candidates to work in small groups, choose and apply concepts covered in earlier sessions and present their findings thereby providing a means of assessing understanding. Facilitation and group discussion allowed candidates to share learning and reflect upon their professional experience in the light of new knowledge gained from the course4. Such reflective learning is invaluable because the individual links their new knowledge to previous memorable experiences, embedding the learning in long-‐term memory and highlighting the application of human factors principles to their individual practice5,6,7. A handout pack was provided at the end of the course, the aim of which was to provide a reference resource and the opportunity for further learning. The pack contained lecture summaries, human factors definitions, published articles, web links and access to e-‐learning.


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Feedback through a post course electronic survey showed that 75% of attendees would highly recommend this course to a colleague giving a net promoter score of 75. As illustrated below, all sessions scored at least 9 out of 10 for application to practice and content.

X axis is percentage awarding score, blue represents a score 9/10, red represents a score of 10/10; y axis is the individual session.

Post course comments included:

“I really enjoyed the course and found it very interesting to hear how the fire service and aviation deal with human factors. I took a lot of useful information from the course and have made changes to my practice following the course.” Simon Hamilton Watch Manager Manchester Airport Fire Service said:

“Combining the course with other high risk industry professionals allowed us to focus upon the course content and prevented any discussion of individual organisational dynamics or politics. We were able to openly engage and discuss experiences of the complex environments that we operate in, these highlighted sources of human error common to all industries like communication, team work & decision making. Personally I feel that human factors theory is valid because it fills the gap between technical knowledge and standard operating procedures. Understanding yourself and others should make working in dynamic high risk environments safer.” For details of the programme please email Heather Gallie; [email protected] REFERENCES

1. Weick KE, Sutcliffe K, Obstfeld Organising for High Reliability: Process of Collective Mindfulness. Res Organ Behav1999; 1:81-‐123. 2. Tamuz M, Harrison MI. Improving Patient Safety in Hospitals: Contributions of High-‐reliability Theory and Normal Accident Theory. Health Serv

Res2006;41(4 Pt 2):1654–1676 3. Gallie H, Perks A. Translating Non-‐medical Safety initiatives into Clinical Environments. https://www.rcoa.ac.uk/system/files/CSQ-‐

Bulletin90.pdf 4. CAP737 Crew Resource Management www.caa.co.uk/cap737 5. Kolb D. Experiential Learning as the Source of Learning. New Jersey: Prentice Hall 1984

www.learningfromexperience.com/images/uploads/process-‐of-‐experiential-‐learningpdf 2005 6. Unit 3: Reflection on and in the workplace www.science.ulster.ac.uk/nursing/mentorship/docs/tollkits/Reflection.pdf27:7,pp619-‐624 7. Constructivist Learning en.wikipedia.org/wiki/Constructivism_(philosophy-‐of-‐education)

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Using a goodwill resource to integrate formative assessments with faculty development O FAROOQ1 AND N SOUNDARARAJAN2

1 CLINICAL EDUCATIONAL LEADERSHIP FELLOW AND 2 CONSULTANT ANAESTHETIST HULL AND EAST YORKSHIRE HOSPITALS NHS TRUST, HULL, UK The rewards from educational activities are illustrated by our ‘Hull Revision day’ experience. When we embarked on this project in April 2008, we never predicted that it would provide opportunities to achieve the core learning outcomes outlined in the ‘Teaching and Learning’ section of the Annex G1 of the Royal College of Anesthetists RCOA’s CCT in Anaesthetics curriculum. We started with the aim of improving Primary FRCA pass rate. We offered it as a free optional resource. Initially, we ran these days on the third Saturday of every month and disseminated information via email. In the first year, revision days included teaching sessions, which integrated the basic sciences. We had access to the seminar room and many consultants devoted their weekend time. As the course evolved, many lessons resulted in change:

1. We valued ‘faculty time’. The ‘drop in’ system gave way to a booking system, which rules that three or more bookings are required eight days prior to the revision day for a “go ahead”.

2. We spotted insufficient bookings in February, June and August, omitted them and scheduled only nine the following year.

3. An IT savvy trainee suggested that a website would facilitate direct communication. We launched our website with url http://frcaheadstart.org/index.html in 2011.

4. Many of our trainees returned as faculty after 2011, earnest in their intention to ‘give back’. Participants loved their enthusiasm and exam tips.

5. Final FRCA preparation revision days started on trainee request in 2011. 6. As our trainees rotated through the region, the word spread making us ‘regional’. 7. Bad weather facilitated the use of technology. Two revision days in 2013 used skype for Structured

Oral Examination (SOE) practice. 8. When the RCOA’s examination calendar changed, we reduced the number of revision days further

to provide more focused preparation. We received an appreciative email from a Training Programme Director (TPD) and the school website carried a link to the ‘Headstart’ webpage. Our inclusive policy lured SAS doctors and trainees from all over the UK. We believe that both participant and peer feedback are needed for educational development and we always provide peer critique. The softer benefits of this have now gained prominence transforming this course into a faculty development programme, which provides opportunities to demonstrate non-‐technical skills that are outlined in Annex G for trainees. Revalidation2 for consultants also requires evidence of these skills. The ‘Headstart’ course provides ample opportunities to demonstrate educational, management and leadership skills. Sixty-‐five revision days have been conducted to date, thirteen of which have been led by trainees. The trainee lead organizes the day, arranges faculty and prepares course material under the supervision of the course director. Leading builds confidence and self-‐esteem. Debriefing skills are also honed by providing constructive feedback. A detailed letter of appreciation to the facilitators acknowledges their specific contribution. On reflection, our learning points include ‘Appreciation begets commitment’; ‘Goodwill multiplies exponentially’; and‘Goodwill resources are sustainable’. REFERENCES

1. CCT in Anaesthetics-‐ Teaching & Training, Academic & Research (inc audit) & Management for Anaes, CC & PM (Annex G). RCoA 2010 http://www.rcoa.ac.uk/node/1438

2. General Medical Council. The good medical practice framework for appraisal and revalidation. March 2011. www.gmc-‐uk.org/GMP_framework_for_appraisal_and_revalidation.pdf_41326960.pdf


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New Council Appointment

NIRMALA SOUNDARARAJAN

I am a consultant anaesthetist with an interest in paediatric anaesthesia, working in a teaching hospital. I am also one of the Training Programme Directors for Anaesthesia in East Yorkshire. I have been involved in undergraduate education, foundation training, have instructed on ATLS, IMPACT and EPLS and have organised training days for anaesthetists. I have been coordinating the 'Revision Day Programme' at Hull from April 2008. This is an optional exam oriented ‘goodwill’ resource, which is run on Saturdays and is now in its eighth year. The revision day programme has the twin aims of exam success

and faculty development. It is mainly delivered by senior trainees and supported by consultants. I believe that education and service are two faces of the same coin and that a workplace that delivers good training will also deliver high quality care. Anaesthetists, as team players, can lead peri-‐operative care and quality improvement initiatives. I would like to work as a part of SEA UK towards ‘Education for Quality’ initiatives focussing on multi-‐professional education, team training and integration of the healthcare workforce to improve patient outcomes ALISTAIR BURNS I am an ST5 registrar working within Warwickshire School of Anaesthesia. I have enjoyed numerous roles within education delivery over the course of my training and hope to develop this within my future career. I am currently engaged in a Masters in Medical Education, which has progressed my understanding of education theory and helped maintain ties with the local Medical School. I am particularly interested in the role of simulation and web resources within medical education. I hope to bring an enthusiasm of these areas to my position as trainee council member.


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Annual Scientific Meeting 2016!

Monday 7th March 2016 !Churchill House, The Royal College of

Anaesthetists !

Theme - "Language in Education - how do we make the most of communication?" !

Summer 2015 SEAUK newsletter - The Society for Education in Anaesthesia … ·...

Documents

Transcript of Summer 2015 SEAUK newsletter - The Society for Education in Anaesthesia … ·...