New rural course pilot poised to transform rural CME

Rural SEMPSIM Day 1_sm Day 1 of the Combined SEMP/SIM Course involves learning how to do the emergency medicine procedures

The Combined Simulated Emergency Medical Procedures (SEMP)/Simulation (SIM) course is an innovative approach to rural CME that has the potential to transform rural critical care medical education in British Columbia.

Like many courses, it is a two day course that trains participants to develop familiarity and fluency with critical care procedures. What sets the Combined SEMP/SIM course apart are the other elements of learning involved in the course: participants are taught how to do the procedures in their own emergency departments, using their own equipment. They are also actively taught how to work interprofessionally with their healthcare team members. Most importantly, once learners have acquired their critical care skills during Day 1, they are placed in various simulated scenarios on Day 2 to learn how to integrate those skills into ‘real life’ practice. Dr. Afshin Khazei, creator of the SEMP course notes that this approach allows educators to “step away from how each procedure was done, and focus instead on how the learners were looking after the overall needs of the patient as a team.”

The SEMP and SIM courses are not new educational offerings. SEMP has been offered to rural physicians for the past eight years – primarily in Vancouver. The SIM course – which is an Interior Health property – has traveled throughout rural communities in the health authority for several years, but has not been offered outside of IHA. The idea to combine the two courses arose from a meeting held at the 2012 St. Paul’s Emergency Medicine Update conference. Dr. Tandi Wilkinson, Associate Medical Director of UBC Rural Continuing Professional Development (RCPD), observed that the idea to combine the two courses arose quickly once CME stakeholders gathered together to talk about coordinating rural medical education offerings. “We thought wouldn’t it be neat to deliver a procedure course and a simulation course together? The theory is that you learn more that way – the procedural skills learned on the first day are incorporated into a lifelike scenario on the second day.”

The first iteration of the Combined SEMP/SIM pilot took place June 7-8, 2014 in Trail, BC. Participants were provided access to online modules ahead of the course. These modules included readings and lectures, as well as computer animated demonstrations of the procedures being taught during the course. The online modules allowed participants to familiarize themselves with the procedures ahead of the in-situ course. “We want to engage learners in the most active form of learning possible,” said Khazei, “so all of the cognitive learning takes place prior to the participants showing up for the hands on portion of the course.”

During Day 1 of the Combined SEMP/SIM course, select critical care procedures (see sidebar) were demonstrated to learners before they were sent off to practice individually. This portion of the morning focused solely on technique and knowledge. Later during the afternoon, interdisciplinary teams of learners managed scenarios using highly realistic human patient simulators, integrating their performance of multiple procedures into the overall care of a critically-ill patient. Communication, team leadership, coginitive errors, and strategies to avoid committing such errors, were discussed during the debriefing after each scenario.

During Day 2 of the course, learners were brought into the trauma bay of their local Emergency Department and ran scenarios using a high fidelity mannequin that provided voice reactions and a wide range of physiological readings that could be pre-programmed or altered ‘on-the-fly’. A nurse manager worked with the learners, occasionally acting out the role of a distraught parent or loved one, adding an extra depth to the scenarios. When the case concluded, the instructors debriefed all of the participants – care team and observers alike – to discuss the case. What were the lessons learned? What did the team do well? Was the communication clear? How could the team improve?

“There is so much learning value in simulation because it’s so real,” says Wilkinson. “You get into this mode of ‘this person’s going to die if I don’t do my job’ and everybody is problem solving and working together. When you talk about it afterwards, you might realize ‘oh, we didn’t have this critical piece of equipment’ or ‘that device was broken’ – you always learn from every simulation you do.”

Khazei reports that the interdisciplinary team training has been very valuable within this combined course. “It’s good for everybody – doctors, nurses, respiratory therapists; most importantly, it’s good for patients. The more that you keep the natural team intact [during the course], the more valuable the experience.”

Evaluations from the participants in the Trail pilot were overwhelmingly positive. Many learners said they wanted more of this type of education, preferably every year. Unfortunately, the Combined SEMP/SIM course is not a simple offering to scale up and deliver. It involves a large amount of equipment and a considerable number of instructors, and a project manager to coordinate all of the logistical considerations. In order to run the course effectively, more regional and/or local instructors (physicians and nurses) will need to be trained, and equipment will need to be purchased or borrowed. There are several groups interested in supporting the course, however, so it may be possible that BC’s rural practitioners will see the Combined SEMP/SIM course being offered regularly in the future. That process will take time to organize.

A course like this one is especially valuable for rural practitioners, notes Wilkinson. “There are lower volumes of critical care cases in rural BC, so you might go a long time before you have to do a particular procedure or see a patient with a particular critical care problem. Participating in Combined SEMP/SIM gives practitioners exposure to procedures and keeps both skills and confidence high.”

The second iteration of the pilot will take place Oct 4-5 in Quesnel, BC. Evaluation of the pilot will take place during fall/winter of 2014.

Learn more about the SEMP Course

Learn more about the SIM Course

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