NHS Lothian
Clinical Skills Mastery Programme
Implementing safe and effective clinical performance
James Tiernan
June 2014
Quality Education for a Healthier Scotland
Postgraduate Clinical Procedural Skills
Is there a problem?
Quality Education for a Healthier Scotland
Learning and teaching skills is a challenge
Quality Education for a Healthier Scotland
One Approach:
The skills carousel
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An alternative approach:
Lothian Clinical Skills Mastery Programme
• Why?
Many trainees are not achieving procedural competencies
• How?
• What?
A skilled team to facilitate learning via safe, simulated practice.
The Mastery Programme
Quality Education for a Healthier Scotland
Knowledge
Skills
Safety
Drills
Performance
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Intended Learning Outcomes
Trainees
After participation in the mastery programme, the doctor in training
will have the skills required to achieve competency in mandatory and
desired procedural skills to the level of safe clinical performance
under supervision.
Tutors
After participation in the mastery programme, the faculty clinicians
will be able to teach clinical procedural skills to doctors in training in
an effective and structured fashion, receiving appropriate recognition
for their contributions.
Quality Education for a Healthier Scotland
Unskilled Doctor
Faculty Development +
Accreditation
Knowledge + Video
Packs
Task Trainer
Lab Sessions
(On line)
Task Trainer In-Situ
Sessions
Supervised
+ Video
Co-ordination
via Online
Booking
System
+
Sessional
Checklist
Skills
Assessment
Supervised
+ Video
Ongoing Clinical
Practice
Supervised
Competent DoctorQuality Education for a Healthier Scotland
Education Packs
•
Reading and Video
•
Online
– New MED Website
•
Checklists
– Formative assessment
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TUtorial Booking System “TUBS”
• https://tutorialbooking.com
•
Advertise a session
•
Sign up to sessions
•
Automatic feedback generated
•
Teaching Log generated for ARCP
•
All of SE Scotland
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Skills Lab Session
•
1 Trainee + 1 tutor
•
Discussion of experience and concerns
• Lab environment
• Demonstration
• Practise
•
Feedback
•
Trouble shooting and discussion
• Establish motor skills + clinical decision making
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Clinical Session (In situ)
•
30mins - 1hr
•
1 Trainee + 1 tutor
•
PAA / ARU / PAA
• Full Asepsis + Drapes
• Entire procedure under supervision
•
Feedback
•
Trouble shooting and discussion
• Establish simulated safety and competence
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Faculty Induction and Development
via
The Clinical Educator Programme
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Faculty
Right Person – Right Skill – Right Way – Right Place – Right Time
• Consultant / Registrar / Specialty Doctors facilitators
– ST3+
– Anaesthetics / ITU / Medical specialties / A&E
• Skill-specific
• Induction process
–
–
–
–
Introductory session
Observation
Facilitation (supervised)
Facilitation (unsupervised)
• Accreditation via Clinical Educator Programme
– Recognised for ARCP / CPD
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How can we effectively teach
procedural skills?
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The Challenge:
TRANSFER
Quality
Learning for Quality
and SafetyEducation
for a Healthier Scotland
Johari Window
Conscious
Competence
Conscious
Incompetence
Unconscious
Competence
Unconscious
Incompetence
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Quality
Learning for Quality
and SafetyEducation
for a Healthier Scotland
Break it Down
Bite Size Chunks
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Procedural Phases
1.
Preparation, Assistance and Positioning
Non technical skills + clinical decision making
2.
Asepsis + Anaesthetic
3.
Procedural Pause
3 Point Check
4.
Insertion
5.
Anchoring + Dressing
6.
Completion
Documentation / Communication / Trouble shooting
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Non- Technical Skills
Category
Element
Gathering Information
Situation Awareness:
Pause to interpret information
Projection to future states
Generating Options
Decision Making:
Balancing Options
Reviewing of Decisions
Prioritising (tasks and patients)
Getting the Job Done:
Maintaining Standards
Planning and preparing
Mellanby et
al. 2013
Utilising Resources
Speaking up
Teamwork:
Establishing shared understanding
Establishing a team
These allow effective and timely
Escalation of care
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Evidence Base
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Evidence Base - Outcomes
• T1 - Lab measurements
– Thoracocentesis / LP / Paracentesis
• T2 - Patient care practices
– CVC / Laparoscopy
• T3 - Patient outcomes
– Bacteraemia, ITU admissions, LOS
• T4 – Collateral effects
– Cost savings, Other trainees
McGaghie et al. 2014,
Medical Education
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Mastery Programme LP Study
Aims – To demonstrate:
• Improved performance of LP via Mastery methodology
– Safety
– Sterility
– Success
• Impact of environment on simulated performance
– Added value of in-situ training
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Mastery Programme LP Study
Reading and Video Learning
Phase 1
Lab Skills Session
Group A
Group B
Lab Skills Session
In Situ Skills Session
Assessment
In Situ
Phase 2
Phase 3
Follow Up Questionnaire / Interview
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Progress
• Sessions
• Faculty
• Feedback
• Study outcomes TBA
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Next Steps
• Expansion into other trainee groups
• Inclusion of other skills
Straight
forward
• Faculty expansion
– Multi-professional tutors
• Enhancing faculty + time protection
Challenging
• Evaluation of Clinical Outcomes
• Mastery Model
– Mandating simulated competency prior to real life
Culture
change
Quality Education for a Healthier Scotland
Unskilled Doctor
Faculty Development +
Accreditation
Knowledge + Video
Packs
Task Trainer
Lab Sessions
(On line)
Task Trainer In-Situ
Sessions
Supervised
+ Video
Co-ordination
via Online
Booking
System
+
Sessional
Checklist
Skills
Assessment
Supervised
+ Video
Ongoing Clinical
Practice
Supervised
Competent DoctorQuality Education for a Healthier Scotland
Safety, Sterility and Success
Thank you
james.tiernan@nhs.net
Quality Education for a Healthier Scotland