Opportunities for Clinical Skills and Simulation training in the Foundation Programme

1
Opportunities for Clinical Skills and Simulation
training in the Foundation Programme

• Dr Alasdair Strachan
• Foundation School Director, South Yorkshire
• Co-Director Montagu Clinical Simulation Centre

2
Opportunities for Clinical Skills and Simulation
training in the Foundation Programme

• Clinical Skills and the Foundation Programme
• The Challenges
• The Opportunities

3
Clinical Skills

• Clinical skills are defined as any action
  performed by all staff involved in direct patient
  care, which impacts on clinical outcome in a
  measurable way. These include
• Cognitive or thinking skills (such as clinical
  reasoning and decision making)
• Non-technical skills (such as team-working and
  communication)
• Technical skills (such as clinical examination
  and invasive procedures)

4
Clinical Skills in the Foundation programme

• Procedures that F1 doctors should be competent
  and confident to do and teach undergraduates
• Venepuncture and iv cannulation
• Local anaesthetics
• Arterial puncture in an adult
• Blood cultures from peripheral and central lines
• Subcutaneous, intradermal, intramuscular and
  intravenous injections
• IV medications
• Intravenous infusions, including prescription of
  fluids, blood and blood products
• ECG
• Spirometry and peak flow
• Urethral catheterisation
• Airway care, including simple adjuncts
• Nasogastric tube insertion

5
Clinical Skills in the Foundation programme

• Foundation doctors will be able to extend the
  range of procedures they can do. Each specialty
  will specify an appropriate range of procedures
  in which Foundation doctors will be expected to
  become proficient e.g.
• Aspiration of pleural fluid or air
• Skin suturing
• Lumbar puncture
• Insertion of a central venous pressure line
• Aspiration of joint fluid

6
Simulation in the Foundation programme
Evidence from recent UK pilot studies has shown
that high fidelity simulators have given
foundation doctors valuable opportunities for
deepening their understanding of the importance
of communication skills and teamwork when
managing acutely ill patients. Medium fidelity
simulators are now available throughout Britain,
and these should be fully exploited.
7
CMO Report Safer Medical Practice Machines,
Manikins and Polo Mints
Improving skills Strengthening teamwork Assessing
skills
8
Learning Curve
Why practice on patients Patient
expectations Coroners inquests which question
training

CMO Report Safer Medical Practice
9
The Challenges availability of trainees

• Problem of release of trainees from wards
• EWTD
• Service commitment

10
Rotherham PGME departmentGeneric Clinical Skills
lunchtime programme

Karen Shaw Clinical Skills facilitator Karen.Shaw_at_
rothgen.nhs.uk
11
Clinical Skills-Drop in Sessions

12
Rotherham Generic Skills Programme Activity
Summary
13
The Challenges trainers

• Problem of trainers
• Availability of skills labs
• Equipment availability

14
Yorkshire and the Humber 87 Acute Trusts have
Clinical Skills lab 73 CS Co-ordinator or ward
based educators All Trusts had clinical skills
equipment, many with underutilised equipment.

15
Simulation Centres

CMO Report Safer Medical Practice
16
Simulators in the Acute Trusts Yorkshire and the
Humber 6 Adult Simulators 1 Paediatric
Simulator 3 Baby simulators

17
The Opportunities
Friday, 2 March, 2001, 0807 GMT One in ten
'harmed in hospital'                           
                                                  
     
18
Simulation, clinical skills and
innovative approaches to education 143. We need
to use modern education techniques if we are to
fulfil our ambition to widen participation in
learning and to enhance the learning environment
for both those in training and those undertaking
CPD. We will therefore review the appropriate use
of e-learning and other modern education
techniques, such as high-fidelity simulation
suites, to develop a strategy for the appropriate
use of e-learning, simulation, clinical skills
facilities and other innovative approaches to
healthcare education.

19
Simulation-based training should be fully
integrated and funded within training
programmes Simulation-based training needs to be
valued and adequately resourced by NHS
organisations

20
Regional SHAs are reviewing simulation facilities
and are making significant investments Yorkshire
and Humber invested 10million this year and
plans further significant investment in the next
two years

21
One in ten 'harmed in hospital'
                                                  
                                Some adverse
events are avoidable Almost 70,000 patients a
year die partly as a result of "adverse events"
they suffer during hospital stays, says a
shocking report. One in ten of all patients
admitted to hospital is harmed by complications,
half caused by medical mistakes of some kind.

• Patient Safety
• Foundation Doctors high risk group
• Clinical Skills failures occurring
• Coroners challenging how skills are trained
• Patients assume we already use simulation

22
Conclusion

• Simulation (including clinical skills)-based
  training should be fully integrated into
  Foundation training (and funded within training
  programmes)
• Innovative patterns of training can enable this
• There are opportunities to ensure this, locally,
  regionally and nationally (including by the UKFPO)