Monday 29 August 2016 4II

Posters: Simulation 2

Location:

#4II01 (134666) Expanded Skills lab, answer to students' call Ninka Havu*, University of Helsinki, Helsinki, Finland Hanna Lampela (University of Helsinki, Helsinki, Finland) Background: In skills labs, students can train in a safe learning environment. A recent study revealed that 90% of medical students from University of Helsinki wished for more practice in practical skills, for which peer-assisted learning is highly suitable. We describe a student centered development process of a Skills lab. Summary of Work: We inquired students’ and teachers’ opinions and wishes on skills training, and use of the Skills lab by web questionnaires. 220 students and 52 teachers answered. After analyzing results, we purchased numerous new training phantoms, recruited three peer assistants, expanded opening hours, and started collecting feedback by a web form. Summary of Results: 83% of ≥3rd year students had practiced in the Skills lab and felt welcome (average 4.2, Likert scale 1-5). Need to call the nurse to get in, lack of time, and unawareness were worst obstacles. In first three months, 66 students’ average grade for the expanded Skills lab was 4.5. Discussion: Students’ and teachers’ wishes for new skills training possibilities were surprisingly similar. Continuous advertising is needed to raise both students’ and teachers’ awareness of existing training possibilities. Supervised teaching events and including Skills lab training in clinical course requirements could attract otherwise passive students. Conclusion: Both students and teachers consider skills lab training beneficial and worth increasing. A diversely equipped Skills lab attracts students, but continuous advertising is essential. Students should be inspired to train by themselves too, in order to gain enough repetition. Take Home Messages: Success in students' practical skills training requires both diverse options in a Skills lab and continuous encouraging.

#4II02 (133805) Integrating high-fidelity simulation in Non-Invasive Mechanical Ventilation Learning - a two years’ experience Daniel Martins*, Hospital Center of Cova da Beira Academic Medical Center, Covilha, Portugal Joana Jesus, Coimbra Hospital and Universitary Center, Coimbra, Portugal Tania Churro, Hospital Center of Cova da Beira Academic Medical Center, Covilha, Portugal Vitor Melo, Hospital Center of Tondela Viseu, Viseu, Portugal Ricardo Tjeng, University of Beira Interior Faculty of Health Science, Covilha, Portugal Luis Patrao, University of Beira Interior Faculty of Health Science, Covilha, Portugal Background: Non Invasive Mechanical Ventilation (NIMV) courses are typically delivered through a theoretical approach. Several authors defend that practical aspects such as dealing with the interface and selecting the ventilator mode and settings are crucial to NIMV adherence in selected patients. Summary of Work: Over the last two years we ran two NIMV courses to medical students and three postgraduate courses to health professionals, adding highfidelity simulation (HFS) scenarios to overcome the usual lack of practical approach in a classical NIMV course. Participants´ post-course questionnaire analysis was done. Summary of Results: Eighty-nine trainees completed the course (32 medical students, 23 physicians, 27 nurses, and 5 cardiopneumologist technicians). Participants´ satisfaction rate was high in all the covered aspects of the questionnaire. All trainees valorised the practical stations (HFS) of the course and mainly the debriefing sessions after simulations. As improvement points, they asked for more clinical simulation based scenarios, and in some cases better adequacy between the clinical cases and the daily role in health care systems (specially cardiopneumologist technicians). Discussion: Integration of HFS in NIVM learning is viewed as a positive method by undergraduate and post-graduated participants from different backgrounds. The HFS can be dynamically adapted to several clinical cases and health care professionals, based on their experience, leading to a more individualized learning. Conclusion: Integrating HFS in NIVM course makes the learning experience more active and individualized, being well accepted by the trainees, motivating their further professional education development. Take Home Messages: The use of high-fidelity simulation in Non-Invasive Mechanical Ventilation courses is well accepted by the participants and motivates their learning.

Monday 29 August 2016 #4II03 (133372) Does a short pre-work conversation help to improve an initial management of acute coronary syndrome?

#4II04 (134725) GeriSim – A multidisciplinary approach to geriatric simulation

Monika Marković*, Faculty of Medicine, University of Maribor, Maribor, Slovenia Dobruška Černela, Faculty of Medicine, University of Maribor, Maribor, Slovenia Sebastjan Bevc, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia

Towhid Imam*, Croydon University Hospital, London, UK Vaughan Holm

Background: We organized simulations of initial management of acute coronary syndrome (IM-ACS) on SimMan 3G advanced patient simulator. Students were given 15 minutes to stabilize a patient with ACS. Summary of Work: 10 groups of 3 medical students, who are at least in 3rd year of study, voluntarily participated in the simulation. We assessed each group in taking quick focused medical history, performing physical examination and diagnosis, application of the correct therapy after venous catheter placement, teamwork and communication with patient. 5 randomly chosen groups had five minutes pre-work conversation (PWC) about 13 important steps in IM-ACS before simulation started. Other 5 groups started simulation without pre-work conversation (noPWC). The aim of the evaluation was to determine whether a short pre-work conversation helps to improve results of IM-ACS. Summary of Results: PWC group’s mean score was 40.8±4.2/50 points. Mean time spent for patient stabilization was 11.5±1.4 minutes. NoPWC group’s mean score was 40.0±3.9/50 points and mean time spent 11.3±2 minutes. A t-test performed for PWC and noPWC groups showed no significant difference between groups (p=0.764). Sub-analysis showed that 5 groups (regardless PWC), which had at least one student from 3rd or 4th year, achieved lower score (mean score 38.6±2.1 points) and spent more time (12.0±1.7 minutes) compared to groups with all students from 5th or 6th year (mean score 42.2±4.0 points, mean time spent 10.7±1.5 minutes) (p=0.113). Discussion: There was no significant difference in final score considering PWC. Our results showed that student’s year of study and consequently clinical experience had impact on the outcome. Conclusion: A short pre-work conversation does not help to significantly improve outcome of initial management of ACS but rather clinical experience during medical education. Take Home Messages: It is more important to enrich students with clinical knowledge and experiences than having a quick review of important steps right before the situation they have to solve.

Background: Despite an increasingly aging population and the increasing age of patients in hospitals, there is a lack of simulation based learning to address managing this patient group. A multidisciplinary approach to this is a cornerstone of elderly care medicine. However, frequent rotations can create a lack of cohesion and understanding within teams. Summary of Work: Junior doctors, physiotherapists, occupational therapists and nursing staff learnt about managing the elderly through simulated scenarios, case discussions and use of a unique geriatric simulation suit. This suit allowed the wearers to feel a variety of impairments that may limit their treatment of the older generation. Summary of Results: The feedback from the session demonstrated that geriatric simulation based learning is uncommon in undergraduate training across all disciplines. Undertaken after graduation it was found to be beneficial and applicable to daily practice. The participants’ fed back that this format is needed to develop the skills to manage elderly patients as a multidisciplinary team. Discussion: A key theme of the session was to gain an understanding of the multidisciplinary team’s roles and of being frail by using the simulation suit. As training is not organised across disciplines this format allowed the team to gain a greater understanding of each other’s perspectives in managing the elderly. Conclusion: Simulation has a key role to play in developing teams to manage complex geriatric patients who commonly present to hospital in the UK. It is hoped that a greater understanding of the patient and each other in the team will increase the quality of care delivered to the older population. Take Home Messages: • The older population is projected to increase significantly in years to come and we need to train our frontline staff to manage these patients safely as teams. • Simulation has a role in helping multidisciplinary teams to learn about older patients and each other’s roles to enhance teamworking.

Monday 29 August 2016 #4II05 (133260) Identifying technical procedures in pulmonary medicine that should be integrated in a simulationbased curriculum: A nationwide general needs assessment Leizl Joy Nayahangan*, Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark Paul Frost Clementsen (Gentofte University Hospital, Hellerup, Denmark) Charlotte Paltved (Skejsim- Medical Simulation and Skills Training, Aarhus, Denmark) Karen Gilboe Lindorff-Larsen (NordSim – Centre for Skills Training and Simulation, Aalborg, Denmark) Bjørn Ulrik Nielsen (Simulation Centre, Odense, Denmark) Lars Konge (Copenhagen Academy of Medical Education and Simulation, Copenhagen, Denmark) Background: In response to today’s demanding healthcare environment, simulation-based training has become a central thread interwoven into the medical curriculum. However, the development of simulationbased training programs is often dictated by what simulation equipment is available commercially. Curriculum development should follow a structured approach which requires deliberate planning. To identify what needs to be integrated into the medical curricula, it is pertinent to perform a “general needs assessment” which is the first step in curriculum building. Summary of Work: We performed a nationwide needs assessment by initiating a three-round Delphi process among 62 key leaders in pulmonary medicine. The first round consisted of an open-ended question to identify technical procedures that pulmonologists should learn. The second round was a survey using a newly developed needs assessment formula to explore frequency of procedures, number of operators, discomfort when performed by inexperienced doctors, and feasibility. The third round allowed for ranking of the procedures according to priority. Summary of Results: The response rate for the first Delphi round was 74% with 30 technical procedures identified. In the second round, 63% answered a developed online survey. Mean scores were calculated for each procedural item and ranked according to priority. The final round resulted in 11 technical procedures that should be integrated in a simulationbased curriculum. Discussion: The development of new training modalities should be guided by a deliberate selection of what procedures are most suitable. A careful needs assessment among the end-users of simulation-based training will allow us to plan our educational activities and live up to the demands of an advancing medical society. Conclusion: General needs assessment is imperative in curriculum development. The prioritized list of 11 technical procedures can be used by medical

educators to plan simulation-based training programs in pulmonary medicine. Take Home Messages: Full integration of simulation in the medical curricula requires a structured general needs assessment as first step.

#4II06 (127263) “Developing Excellence Amongst Future Clinical Leaders” - Evaluation of an innovative, interprofessional simulation pilot for higher specialty trainees Patience Ehilawa*, Trent Simulation and Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK Nicholas Woodier, Trent Simulation and Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK Bryn Baxendale, Trent Simulation and Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK. Vicky Garrod, Northampton General Hospital, NHS Trust, Northampton, UK Fiona Poyner, Northampton General Hospital, NHS Trust, Northampton, UK Background: The complexity and constraints of modern healthcare necessitates collaboration among emerging clinical leaders which requires a strong focus on interprofessional education. Summary of Work: Six multifaceted high fidelity simulation targeted at senior general internal medicine registrars (residents) and nurses will be piloted across two centres. Using a one-to-one rotational model that allows for personalised debrief, the simulation aims to foster collaborative working and address deficiencies in traditional curriculum training models such as high stakes decisions, challenging communication, complex capacity assessment, supervising trainees and root cause analysis of critical incidents. Self-evaluation and JeffSATIC1 questionnaires will be administered pre and post simulation to explore attitudes toward interprofessional collaboration. Participants will be invited to a semi-structured focus group interview to explore perception towards interprofessional simulation. Summary of Results: The first simulation pilot is scheduled for 15/03/2016. Preliminary results will be available for AMEE 2016. Assuming normal parametric distribution, descriptive analysis will be calculated for items on the questionnaires. Pre and post JeffSATIC scores will be compared using paired T-test. Discussion: Simulation provides experiential learning without compromising patient safety and is an effective model for developing interprofessional collaboration. This pilot provides a user-centered model that can potentially transform the way health professionals acquire decision making and clinical leadership skills. Conclusion: Healthcare needs to better prepare its staff to work collaboratively and as clinical leaders. This innovative approach seeks to address that need.

Monday 29 August 2016 Take Home Messages: Interprofessional simulation based training replicates real workplace challenges and can be utilized to prepare staff for complex decision making and leadership roles. Reference 1. Hojat et al, The Jefferson Scale of Attitude Towards Interprofessional Collaboration (JeffSATIC): development and multi-institutional psychometric data. Journal of inter-professional care, volume 29, issue 3, 2015, page 238-244

#4II07 (134264) Low cost and creative approach for realistic simulation: Photographs as the simulated props Pin-Tarng Chen*, Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan Hung-Wei Cheng Background: Sometimes it’s hard and complicated or time consuming to “make up” the simulator to conduct medical simulation, such as the surgery processes, by using commercial props and materials. Summary of Work: In order to preserve the realism that related to the scenario, we tried to create the complicated “realism” by high-resolution pictures. At first, the pictures were photographed as the similar clinical conditions. The pictures were then amended by computer software to ensure the contents were in their actual proportion, color and luster. The pictures were printed in high resolution by high-grade thick paper in order to be curved around the limb or abdomen. Before starting the scenarios or different frames, the edges of pictures were pasted by sellotape or Tegaderm in corresponding areas. Summary of Results: The method had been used to create necrotizing fasciitis, diabetic foot gangrene, total knee arthroplasty, and surgical conditions during each stage of liver transplantation. Questionnaires to survey scenario realism, print photo quality, photo realism, agreement of the photograph method were obtained from 60 participants and 21 faculty. Overall evaluation was extremely positive. There were no ratings of fair or poor by any participants. Discussion: Realism is fundamental for simulation. In our experience, commercial props and materials suitable for scenarios are not always readily available, and it is sometimes difficult and complicated or timeconsuming to create simulations of surgical processes and wound. The high-resolution pictures were used and the preserved the realism. In the cases of complicated structure or difficult production, we advocate to use high-resolution photographs for creation of surgical field and wound, rather than complicated moulage or make-up. Conclusion: High-resolution pictures photographs could be used as a low cost and creative approach for realistic simulation. Take Home Messages: Creativity is an essential tool for increasing realism by using available resources.

#4II08 (136208) A non invasive mechanical ventilation course based on high fidelity simulation: a portuguese pionneer approach Joana Jesus*, Coimbra Hospital and Universitary Center, Coimbra, Portugal Daniel Martins, Hospital Center of Cova da Beira Academic Medical Center, Covilha, Portugal Tania Churro, Hospital Center of Cova da Beira Academic Medical Center, Covilha, Portugal Vitor Melo, Hospital Center of Tondela Viseu, Viseu, Portugal Ricardo Tjeng, University of Beira Interior Faculty of Health Science, Covilha, Portugal Pedro Lito, University of Beira Interior Faculty of Health Science, Covilha, Portugal Background: Non invasive mechanical ventilation (NIMV) courses are typically delivered based on a theoretical basis and usually lack a clinical and practical approach, as real situations where NIMV should be used are hard to replicate. There are many european annual NIMV courses, but until 2014 none of them was based on high fidelity simulation. By April 2014, a high fidelity simulation-based NIMV course was created in Portugal in the Faculty of Health Sciences – University of Beira Interior, to enhance students’ clinical and practical skills on this specific theme. Summary of Work: Two pre-graduate courses of NIMV were developed to 5th year medical students and two graduate courses of NIVM to junior and senior doctors, using high-fidelity simulation (HFS) scenarios. Participants´ post-course questionnaire analysis was done. Summary of Results: Fifty-five participants completed the course (32 medical students, 23 physicians), 74,5% females and their median age was 26,23±5,9 years. After the course the participants changed positively their opinion about using HFS in a NIMV course. All valorized the practical stations (HFS) of the course and mainly the debriefing sessions after simulations. Discussion: The presented work was developed to overcome the usual lack of practical approach in a classical NIMV course. These courses started as being optional in our faculty, but due to participant’s satisfaction and their importance, they are now part of the 5th year medical curriculum. Conclusion: We found that adding HFS to a classical NIMV course was important to increase participants’ self-perception about their practical knowledge and skills related to NIMV therapy. In the future we want to continue this investigation to verify if HFS in NIMV course objectively traduces better clinical results. Take Home Messages: Since April 2014 there are now NIMV courses based on high fidelity simulation on a portuguese medical school and they seem to accompany participants needs and to enhance their satisfaction and knowledge.

Monday 29 August 2016 #4II09 (135109) The Influence of Medical Simulation Competition on Obstetric Staff

#4II10 (135587) Medical simulation for medical students - practicing initial treatment of critically ill patients

Hui-Yun Fu*, Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan Ching-Ju Shen (Department of Clinical Education and Training Kaohsiung Medical University Hospital{1}; Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital {2}; Graduate Institute of Medicine, College of Medicine {3}, Kaohsiun

Rolf Konig*, Medical Simulation Centre, Department of Anaesthesia and Intensive Care Medicine, University Hospital in Trondheim, Trondheim, Norway Alba Berglun Lovaas (Medical Simulation Centre, University Hospital in Trondheim, Trondheim, Norway) Herborg Haugen (Medical Simulation Centre, University Hospital in Trondheim, Trondheim, Norway) Hilde Stuedahl Mohn (Medical Simulation Centre, University Hospital in Trondheim, Norwegian University of Science and Technology, Trondheim, Norway) Stine Gundrosen (Medical Simulation Centre, University Hospital in Trondheim, Norwegian University of Science and Technology, Trondheim, Norway) Tore Amundsen (University Hospital in Trondheim, Norwegian University of Science and Technology, Trondheim, Norway)

Background: Obstetric risks are unpredictable, with short onset and little reaction time. The Joint Commission of Taiwan has hosted the first medical simulation competition on high-risk obstetrics in 2015 to make the participants recapture the essential medical managements and the importance of teamwork through simulating various emergent obstetric scenarios. With the instructions from the observing experts and feedbacks from the participants, we were able to enhance patient safety and care quality. Summary of Work: Each team of the simulation competition is composed of 5 members from the obstetrician department, who practiced the lessons learned from the competition on the daily basis. Questionnaires were designed and focused interviews were conducted for other medical staff to document any changes or impact brought by the 5 participants in simulation competitions. Summary of Results: From the results of the questionnaires, it has been found that medical staff was prone to miss alarming messages in the process of mother-infant care. Focused interviews help training other medical staff for common mistakes and the important routine skills, such as patient identification and briefing with ISBAR system to ensure patient safety. Through simulations, patient care quality was enhanced and medical errors reduced on the daily basis not only by the 5 competition participants, but also other medical staff. Discussion: Although only 5 members were directly involved in the medical simulation competition, its impact extends to the entire obstetrician department in terms of enhancing patient safety and reducing medical errors. Simulation should be recruited as part of obstetrics training programs. Conclusion: Medical simulation competition had an impact beyond individual participants, extending change into the organizational culture. Take Home Messages: Medical simulation competition influenced the attitudes of obstetric team members and created the culture of patient safety.

Background: Education of highly qualified personnel for health services must aim at achievement of best evidence- and standard based competence. During clinical rotation medical students frequently meet patients after the initial treatment has been implemented. The patients are often sick, old and bedridden non-communicative with scant clinical signs inadequate to meet the students learning objectives. To ensure that all 3rd year students got sufficient practice in initial diagnosing and treatment of COPD exacerbation and septic pneumonia; simulation was introduced by the department of Thoracic Medicine, Trondheim University Hospital in 2011. Summary of Work: At the Medical Simulation Center groups of 8 students participated in two scenarios (one of each category) using a man-sized advanced patient simulator (SimMan 3G, Laerdal Medical, Stavanger, Norway) with palpable central and peripheral pulses, chest movements, verbal response (a wireless sound transmitting system) and a monitor showing the patient’s physical parameters. 4 students interviewed, investigated and treated, while the 4 others observed, then the students switched roles. A consultant and nurse were accessible, and the scenario ended with the consultant entered the room for discussion, followed by debriefing with all 8 students. Summary of Results: More than 600 medical students at NTNU have participated in this simulation training. Based on the positive experiences from both students and consultants, simulation has also been implemented in the cardiology rotation since 2014. Discussion: Tailored patient case scenarios involves each student in a close-to-reality setting. The students prepares for real-life patient encounters supervised by an experienced teacher in a safe environment. Conclusion: Medical simulation provides opportunity to bridge the gap between theoretical knowledge and professional competence meeting the students learning objectives. Take Home Messages: Clinical rotation is based on a random selection of seriously ill patients. Simulated

Monday 29 August 2016 patient scenarios provide learning outcomes not readily obtained in real life.

#4II11 (133996) Evaluating the feasibility of using simulation training to teach junior doctors the management of diabetic emergencies Susan Gelding*, Department of Diabetes and Endocrinology, Newham University Hospital, London, UK Kirun Gunganah, Department of Diabetes and Endocrinology Newham University Hospital, London , UK Catherine Gouveia, Department of Diabetes and Endocrinology Newham University Hospital, London,UK Keir Phillip, Department of Diabetes and Endocrinology Newham University Hospital, London, UK Background: Over 20% of inpatients at our district hospital have diabetes. Most out-of-hours management of diabetic emergencies (MDE) is provided by junior doctors. Evaluation of junior doctors’ understanding of MDE has shown consistently poor results (Gouveia 2011). Historically, we have provided training on MDE to junior doctors by small group teaching sessions, case-base discussions and grand round lectures. With a growing popularity for simulation training, we wanted to evaluate whether teaching MDE using simulation could be effective and preferred by junior doctors. Summary of Work: We designed a three hour simulation session with scenarios covering the management of the common diabetic emergencies: diabetic ketoacidosis, hyperosmolar hyperglycaemia syndrome and hypoglycaemia. Twenty-one junior doctors (1-3years post-graduation) agreed to participate and tackled each scenario in groups of 2-3 trainees. We evaluated their experience of the simulation training by anonymous feedback forms utilising Likert scales and free-text response boxes. We also interviewed 7 self-selected participants to further explore the feasibility of simulation training as a mode of teaching MDE. Summary of Results: All 21 participants provided anonymous feedback. All “strongly agreed” or “agreed” that the simulation sessions were relevant to their training, interesting and informative. 20/21 trainees felt that simulation training was a better method of teaching MDE than traditional lectures. Participant interviews highlighted various themes which made simulation best tailored for this teaching including deep learning following reflective practice, increased confidence, realism and practicality. Discussion: Trainees found using simulation to learn MDE, increased their confidence and was more realistic than learning from lectures, provided practical experience with reflection, promoting deeper learning. Whether this translates into safer patient care is unknown and likely to be challenging to evaluate. Conclusion: Simulation training is a feasible and popular method for teaching junior doctors MDE.

Take Home Messages: Teaching MDE by simulation to junior doctors • is achievable in a district hospital • increased trainees’ confidence • is preferred to traditional lectures.

#4II12 (133940) Autonomous learning platform (HybridLab) is an effective medical simulation based tool for development of the technical and non-technical competences Povilas Ignatavicius*, Lithuanian University of Health Sciences, Kaunas, Lithuania Rita Gudaityte (Lithuanian University of Health Sciences, Kaunas, Lithuania) Paulius Dobozinskas (Lithuanian University of Health Sciences, Kaunas, Lithuania) Dinas Vaitkaitis (Lithuanian University of Health Sciences, Kaunas, Lithuania) Asta Krikscionaitiene (Lithuanian University of Health Sciences, Kaunas, Lithuania) Zilvinas Dambrauskas (Lithuanian University of Health Sciences, Kaunas, Lithuania) Background: HybridLab is a fusion of distance learning and medical simulation that allows residents to train 24/7 at their work place without presence of the instructor and/or technician. Summary of Work: In 2014 the advanced trauma life support course developed on the HybridLab platform was evaluated. Twenty-seven surgical residents of Lithuanian University of Health Sciences were enrolled. Skills were grouped into 7 categories according to ABCDE principles and were independently evaluated by 3 reviewers. Reviewer 1 was present during the simulation and Reviewers 2 and 3 assessed skills using the video recording system. Progress of the students and the interobserver agreement were evaluated. Summary of Results: There was a 2.5-fold increase in the overall score of the course (from 35% to 89%), and the significantly increased performance levels were observed in each group of practical skills. Reevaluation after 6 months revealed only slight decrease in the overall score (from 89% to 82%). Analysis showed moderate to substantial (range 0.45 – 0.77) agreement between reviewers in five categories and didn’t differ between reviewers present during the simulation and those using video recordings. Discussion: Participants significantly improve their skills using the learning platform without instructor and/or technician. Interobserver agreement is overall good when comparing results of skills assessment by reviewer present during the simulation exercise and online reviewers. In almost all categories the kappa levels are moderate or substantial, implicating that practical skills of the course participants can be evaluated online. Conclusion: HybridLab is an effective medical simulation based tool for development of the technical and non-technical competences. In order to

Monday 29 August 2016 achieve better agreement, we must more clearly define the rules of the skills evaluation. Take Home Messages: Clear and structured algorithms, well defined rules of formative and summative assessment are the key factors ensuring the functioning and reliability of the autonomous learning platforms.

#4II13 (133596) Assessment of Team Behaviour during Simulationbased Scenarios in Paediatric surgery Caroline Ong*, KK Women's and Children's Hospital, Singapore, Singapore Amelia Chua Kristy Beckwith Doris Dimatatac LW Chiang CL Bong Background: High-fidelity simulation training is regularly used to train interprofessional healthcare teams in resuscitation. However, it remains difficult to assess training efficacy in terms of improving teamwork. There are various checklists available to assess team-based competencies but they are not validated locally. Summary of Work: We chose 2 tools best suited to our context -Mayo High Performance Teamwork Scale (MHPTS) and Team Emergency Assessment Measure (TEAM).We aimed to confirm their reliability for evaluation of our simulation training programme. Content validity was assumed as the context of our training program is similar to prior validation studies. Nine teams of junior doctors and nurses participated in video-recorded simulation team training with immediate debriefing. With ethical approval, these video-recordings were rated by 3 blinded expert observers using the MHPTS and TEAM. Data was analyzed using Cronbach’s alpha and intraclass correlation to assess the internal consistency. Summary of Results: Cronbach’s alpha calculated for MHPTS and TEAM was 0.60 and 0.75 respectively while intraclass coefficient calculated for MHPTS and TEAM was 0.34 and 0.50 respectively. Discussion: Both tools were fairly reliable but TEAM had greater internal consistency and inter-rater reliability. Our experts preferred TEAM because it had clearer behaviour descriptors, while MHPTS had some repetitive items that could overweight certain components of teamwork. When considering assessment tool utility apart from reliability and validity, tools also fulfilled other criteria of feasibility, acceptability and educational impact. Conclusion: In our simulation team training program, both MHPTS and TEAM were reliable for expert assessment of teamwork, but TEAM had better interrater agreement and internal consistency. Take Home Messages: Reliability of assessment tools is context specific.

#4II14 (133570) Simulation-based training of difficult patient management for resident Shoichi Ito*, Chiba University Hospital, Chiba, Japan Kiyoshi Shikino (Chiba University Hospital, Chiba, Japan) Kazutaka Noda (Chiba University Hospital, Chiba, Japan) Mayumi Asahina (Chiba University Hospital, Chiba, Japan) Takahiro Soma (Chiba University Hospital, Chiba, Japan) Masatomi Ikusaka (Chiba University Hospital, Chiba, Japan) Background: We frequently experience difficult patient (DP) encounter, and have to manage such patient appropriately for providing patient-centered care. The physicians develop their abilities to manage DP encounter on their own, but their management quality were diverse. To provide learning opportunities for DP management just enough, we developed its simulation-based training program for residents. Here, we report effectiveness of the training program and the factors influencing the training effect. Summary of Work: All 32 second-year residents in our hospital participated in simulation-based training of DP management. Participants were assigned either to direct encountering simulated DP group (n=18) or to just monitoring the DP encounter group (n=14). All residents’ pre-training psycosocial beliefs were assessed using The Physician's Belief Scale (PBS), which measures psychosocial orientation. All participants were debriefed and discussed for better DP management with attending physicians after each encounter. All participants completed self-assessment questionnaires of their training effects immediately before and after training. Summary of Results: The training improved residents’ confidence and learning motivation for managing DP in both direct and indirect DP encounters. Almost all participants reported that they could acquire new knowledge and skills. Positive correlation is observed between the participant’s pre-training PBS and training effect. Discussion: Simulation-based training of DP management is useful for developing trainee’s knowledge, skills, confidence, and learning motivation for managing DP. Debriefing session following simulated DP encounter is considered essential for the training because both direct and indirect DP encounters of simulated patients are effective. Recognizing importance of psycosocial approach in patient-centered care quality is considered necessary for better DP management. Conclusion: Simulation-based training of DP management followed by debriefing session, especially regarding psycosocial approach, is effective for improving resident’s abilities and capabilities for DP management. Take Home Messages: We can improve resident’s knowledge, skills and attitudes for DP management effectively by simulation-based training. Psycosocial approach is important for better DP management.