The use of distance learning technologies to bring simulation-based critical care training to a remote community in northern Canada

Timothy Willett, RCPSC; Susan Brien, RCPSC; Pierre Cardinal, RCPSC & uOttawa; Rick Hodder, uOttawa; John Kim, uOttawa; Dave Neilipovitz, uOttawa; Shahin Shirzad, UBC.

2011 MedBiq Conference, 11 May 2011

Critical care

•Patients with an imminently life-threatening condition

•Time is tissue

•Community:• Critical illness can happen anywhere• Community practitioners recognition & early

intervention

•Training:• Simulation-based• ABCs, crisis resource management

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Vancouver

Toronto

Montreal

Ottawa

Iqaluit

Iqaluit (formerly Frobisher Bay)

•~3000 km from tertiary care

•Population 6,200

•Only hospital in Nunavut (population 30,000)

•Nunavut > 2,100,000 sq km 15th in world!

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Challenges

•Health human resources

•Transport

•Access to CPD

•Cost (either way)

•Goal: Test a distance-learning model of a simulation-based critical care course (ACES)

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Methods

Funding:• Health Canada• RBC Foundation• Royal College

1) Needs assessment• Context• Priority needs• Learners

2) Modify course

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Methods

3) Delivery• Web modules• Lectures• Case discussions• Task training• Simulation

4) Evaluation• Questionnaires• Pre- and post-course quiz• Post-course simulation (on-site)• Delayed interviews

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TeleMedicine

SimuCase Virtual Patient

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Learners

Operator

Facilitator

Results: Sessions

•4 web modules• poorly used• access issues• well-liked

•TeleMedicine: 8 sessions• 4 hrs lecture & cases• 3.5 hrs task training• 4 hrs SimuCase VP

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“In terms of the [TeleMedicine], the mannequins, that kind of thing and

doing this all kind of on a long distance basis, I think it was

effective.”

Results: Questionnaire

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Relevant

Videoconference effective

Technical skills improved

Confidence increased

Will not change practice

SimuCase allowed practice

SimuCase feedback useful

Results: Quiz

•28% improvement

•Paired t-test (n=10): p=.016

•Cronbach’s alpha: 0.67

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Group n Mean score (/20)

Iqaluit (pre) 15 9.5

Iqaluit (post) 10 12.5

Junior ICU residents 5 7.7

Senior ICU residents 6 13.6

Results: High-fidelity simulations

•2 cases

•10 physician candidates: 1 leader, 1 assistant

•RN actor

•2 facilitators from Ottawa

•Videotaped

•Checklist: Custom, Delphi process

•GRS: “Ottawa GRS”

•Standard: Modified Angoff

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Results: High-fidelity simulations

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Measure Case 1 (GI bleed) Case 2 (Sepsis)

Expected score

Mean candidate

score

% met or exceeded expected

Expected score

Mean candidate

score

% met or exceeded expected

Checklist score 19.0 24.6 90 20.1 26.7 100

Ottawa GRS: Overall performance score

4.2 5.3 70 4.2 5.7 100

• Leadership skills 4.5 5.6 60 4.5 6.1 90

• Problem-solving skills 3.8 5.4 90 3.8 5.6 100

• Situational awareness skills

4.3 5.1 70 4.0 5.6 100

• Resource utilization skills 4.0 5.6 100 4.0 5.9 100

• Communication skills 4.8 6.1 90 4.8 6.2 90

Results: Delayed interview (prevalent themes)

• Positive experience, appreciative

•Well qualified instructors

• Technical problems not significant

• Changes in:

• Approach to critically ill patient / priorities• Vasoactive medications• Assessment / monitoring• Confidence• Communication

•Delivery strategy was effective; liked the on-site simulations

• SimuCase was effective; enhanced skills applicable to high-fidelity simulation

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Lessons learned

•Support from decision-makers

•Community-based coordinator

•TeleMedicine tech support

•Web modules: disc backups

•Virtual patient works

•Outcomes positive

•Limitations:• Pilot study, small n, limited rigour

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Thank you

•Questions?

• twillett@royalcollege.ca

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