CLINICAL SKILLS Managed Educational Network
Excellent Skills for Excellent Care
Newsletter: Issue 26 – September 2014
Autumn News
Read on to learn about the new and exciting projects CS MEN have been
involved in over the summer as well as our regular updates.
NHSScotland Event 2014 Report
This year NES had a considerable presence at the NHSScotland Event with
Anne, Lynn and Andrea all helping to man the stand. CS MEN worked with
BASICS and the Scottish Centre for Simulation and Clinical Human Factors
(SCSCHF) to bring a live demonstration of an interdisciplinary team training
session to the main hall of the Conference. The scenario was built around a car
crash that had resulted when a parent lost control of the car rushing their sick
child to hospital in a remote part of Scotland.
The parent, played by Jason Leitch / Pennie Taylor, was trapped in the car and
needed to be carefully extricated from the vehicle.
The child, ably played by SimJunior, had suspected meningitis and received road
side treatment which included antibiotics administered intraosseously.
This live demonstration drew large crowds resulting in a lot of interest over the
two days in the work of CS MEN and BASICS
We also had the opportunity to showcase two of our most recent online
resources. On the first day Paul Smith, University of Dundee, was available to
showcase the Intramuscular Injections Resource and IM Simulator with
delegates being encouraged to come along to the stand and have a go to update
their skills. Paul was kept busy during the day, particularly during the lunch
break and in the afternoon where he had some very useful conversations. On
the Wednesday our Lumbar Puncture Resource and Simulator was showcased
by Russell Hewitt, NHS Greater Glasgow & Clyde, one of the co-authors, who
was present to guide delegates in the technique and to answer any questions.
BASICS Scotland were invited to be included in this year’s NHSScotland event
as part of the NHS Education for Scotland presentation.
For me the days were very worthwhile with good interaction from the many
delegates across all aspects of health care.
At BASICS our task was made easy by having a large centre piece exhibit in the
form of our unique extrication car which was used as a backdrop for information
for most of the day, but played a more active role during the live extrication
demonstration.
I enjoyed the interaction with SCSCHF and the good folks at CS MEN. We also
had the benefit of having the Scottish Ambulance Service in an adjacent
exhibition area to help with the smooth extrication of our ‘volunteer‘ casualties.
The team at BASICS Scotland had an opportunity to interact with the many
delegates over the two days and also to see the wider work carried out by NHS
Education for Scotland and other aspects of health care
Graeme Ramage
Sandpiper Fellow
CS MEN R&D Conference Report
The R&D Conference is one of the highlights of the CS MEN Year when we get
together to hear reports from past and present CS MEN R&D Awards winners.
This year's Conference was held on 23 June 2014 in Stirling Management
Centre, with Dr Vivien Swanson, NES, starting the day with an inspiring talk titled
“Hands, Heads and Bumps”. The latter part of the morning was chaired by Jerry
Morse, Regional Champion, North, where 5 presentations from recently
completed research programmes were showcased. These covered a wide range
of topics – for more details click http://www.csmen.scot.nhs.uk/events/cs-menannual-rd-conference.aspx . In the afternoon the 2014 Award Winners
presented their planned research with Anna O’Neil, Regional Champion, West,
ably chairing this lively session where the award winners were put through their
paces by the Conference delegates. To round the day off Professor Peter
Davey, University of Dundee, spoke on the subject of Quality Improvement: The
Hard Science.
As well as listening to stimulating presentations, this year we added in interactive
group sessions to consider the issues around disseminating and embedding
research. These sessions always prove to be well received and encouraged
wide ranging and thought provoking discussions.
Thank you to all who attended. We look forward to future events where we learn
of how this research is being embedded into practice.
Human Factors Update
August 2014
At the NES Human Factors Conference in March 2014, Malcolm Wright as NES
CEO, confirmed that NES is committed to developing a team to provide
educational leadership in the areas of Quality, Safety, Human Factors and
Clinical Skills.
Internal changes within NES mean that Stewart Irvine, our Director of Medicine
has become the Executive Lead for this work. We are developing an integrated
approach to developing the team and agreeing educational priorities through
internal workshops bringing together key individuals across NES in the first
instance. The second of these workshops is scheduled for September and the
proposals generated will be shared with other stakeholders.
In the meantime, we are responding to one of the key priorities that emerged
from Health Board representatives at the national conference – the need for an
entry level, awareness raising educational resource that introduces a wide range
of staff to the principles of Human Factors science and the potential to enhance
quality and safety in health and social care.
Fiona Anderson, Training and Education Manager and Elaine Pacitti, Educational
Project Manager in the Professional Development Workstream in the NES
Medical Directorate, have established a short life working group to develop an
entry level e-learning resource. This will integrate with other educational
initiatives and resources in the areas of Quality Improvement and Patient Safety
and with the Leadership and Management Programme (LaMP). A pilot elearning resource will be reviewed by an expert reference group in the first
instance, with a view to piloting and evaluating in 2015.
In primary care, Paul Bowie as project lead for the Health Foundation SHINE
funded project on enhanced Significant Event Analysis, using a Human Factors
framework, has completed the project evaluation. This can be accessed on:
http://www.nes.scot.nhs.uk/education-and-training/by-theme-initiative/patientsafety-and-clinical-skills/enhanced-significant-event-analysis.aspx
Following this successful pilot, there is interest in adopting the same approach in
both dentistry and pharmacy.
In addition, Paul and his team have been invited by the Health Foundation to
apply for funding to engage with professional design experts. The intention is to
redesign and brand the tools used in the pilot study and to develop a web based
resource, with the option of an app that can be downloaded to smart phones and
tablets as part of a strategy to embed and spread the use of these resources in
general practice.
Philip Cachia,
NES Clinical Skills and Patient Safety Lead
Mobile Skills Unit Report
The MSU has had an exciting summer with visits to Bixter Health Centre and
Montfield Hospital in Shetland, the Isle of Tiree, the Isle of Islay, Barra and
Benbecula on the Western Isles, Portree and Broadford in Skye. We are
delighted to share some of the reports we have received so far.
Shetland
Julie Redpath, Resuscitation Training Advisor and our Host in Shetland
was pleased to report:
Number of
Department Breakdown
Attendances
Aith Life Boat Services
2
Child Health
1
Community
15
Maternity
2
Medical
3
more intense programme of
Physiotherapy
5
learning to be prepared. A footfall
RGU Students
10
Staff Development
1
Theatres - GBH
11
that it was here. As always the
Ward 1
12
Unit served up a diverse
Ward 3
8
Total Number of Attendances
70
The Unit visit has become a regular
summertime teaching event for
NHS Shetland over the last 5
years. This experience, year on
year, has enabled a shorter but
of 70 onto the Unit is impressive
given the short period of two weeks
programme attended by a diverse
range of folk.
We were delighted to host not only the Paediatric Intensive Care Unit Retrieval
Service but also the Emergency Medical Retrieval Service who were able to
deliver sessions including specific case scenarios. Their sessions were
extremely well attended.
Students following the Advanced Clinical Examination Skills Course were
able to make use of the simulation equipment held on the Unit to practise their
developing examination skills.
Clare O’Sullivan, Community Nurse with a special interest in tissue
viability, provided community staff with opportunities to enhance their knowledge
in caring for leg ulcers and wound management.
There was also the opportunity to provide the more traditional life support skills
training and Julie Redpath and Maggie Drosso were delighted to help support
Aith Life Boat Station in the challenging work they do.
Challenges:
The main challenge of this year’s visit came after the Unit was moved from Bixter
Health Centre back to its base outside Montfield Services. After the recent
building works there, it became apparent that the electrical hook-up was no
longer working. However, NHS Shetland Estates staff pulled out all the stops
to provide a generator and after a few teething problems all was well!
Thank you:
Garry McMillan and James MacLeod for driving and setting up the Unit – couldn’t
have done it without you! Laurence Abernethy for the daily organisation with the
generator and for getting the Unit ready to leave on the ferry – Thank you!
Estates Staff and Staff Development Team for their help with the challenges!
Great problem solving! And lastly, to all those who gave up their time to teach,
organise or work behind the scenes – a great big thank you!
Isle of Islay
Joe Hughes, Paramedic Team Leader and our Host on Islay reported:
This was the MSU’s fifth visit to the Isle of Islay, as with the previous visits its
duration was two weeks. The visit was fully supported by the local health board
by supplying staff from other locations to free up local staff to attend training
courses, along with providing a trainer to deliver training.
For the first time members of the Home Help Carers Network were brought onto
the Unit for BHF Heartstart training, which will benefit the most vulnerable people
in the community. In addition swimming pool staff also came on board for
training. Palns are now afoot to develop onsite training with them.
The number of staff trained on the Unit remains constant (over 300), with a mix of
NHS, Scottish Ambulance Service (SAS), Police, Scottish Fire & Rescue, Airport
Fire Staff and members of the public benefitting from training. This year
the EMRS Team did not manage to come over due to the Commonwealth
Games taking place, but despite this, the Paediatric Retrieval Team and Neonate
Services did deliver training. In addition, external trainers delivered maternity
training to all staff, along with in house training.
Exercise Tempest
A second Multi Agency Exercise on Islay called “Exercise Tempest”, which saw
emergency services responding to an explosion at the Bowmore distillery, took
place on Saturday 5 July 2014. The aim of the Excercise was to test the multiagency response to multiple casualties during daylight hours. 17 live casualties,
4 dead, including a baby, the SAS, Scottish Fire & Rescue, GPs, Police, hospital
staff and members of the public all played their part in this live scenario. In total
78 people were involved in what proved to be a very worthwhile cross agency
response to a major incident.
The Mactaggart Leisure Centre, next to the distillery, was set up as a clearance
station and the Unit was used for the moulage. It was the first major incident
that Bowmore Hospital had been involved in.
The incident went well and there were no adverse effects on the outcome of the
casualties, with the casualty clearing station and the hospital working well
together.
The Exercise highlighted a number of issues, namely a lack of resources for
organisations to work to their generic major incident plans. However, there is now
a willingness to address this with a local plan being taken forward in the coming
months.
Sincere thanks goes to everyone who supported the Unit’s visit to Islay.
MSU Faculty Development Course
There are still spaces available on the MSU Faculty Development Courses,
please see dates below:
27 & 28 November 2014
5 & 6 February 2015
26 & 27 February 2015
26 & 27 March 2015
Please contact me (lynn.hardie@nes.scot.nhs.uk) to book a place.
MSU Diary for the rest of 2014
Date
12 - 19 September
22 – 28 September
29 September – 10
October
11 – 17 October
27 October – 7 November
1 – 12 December
Location
Fort William
Isle of Mull
Nairn
Elgin
The Southern General, Glasgow
Monklands Hospital, Airdrie
The MSU diary is open to book your 2015 visit! Contact me as soon as
possible to avoid disappointment lynn.hardie@nes.scot.nhs.uk
Resources Update
The long-awaited study guide on Professionalism and Professional Accountability
in Clinical Skills Practice is now available as a PDF on our website. It was based
on original workbooks from NHS Lothian, NHS Tayside, NHS Fife and the
University of Dundee and is relevant to all health care practitioners in Scotland
who are involved in the delivery of procedural clinical skills. The aim of this
workbook is to explore aspects of professionalism and accountability and the
implications for professional practitioners, e.g. medics/nurses/midwives/allied
health practitioners.
This good practice study guide was developed by authors from different health
care professions to enable practitioners to develop their knowledge, skills, values
and attitudes of professional issues embedded in acquiring and practising clinical
skills. Adopting a multi-professional approach to clinical skills training will help to:
 promote standardised practice in the delivery of health care procedures
 encourage effective working relationships
 provide patients with access to multi-skilled, flexible health care
practitioners.
All our resources can be accessed via the resources page on our website at
http://www.csmen.scot.nhs.uk/resources.aspx
RHIC: Reducing Harm, Improving Care
RHIC is an inter-professional network of students and staff dedicated to learning
about improving healthcare in the workplace.
Background: A Brief History of RHIC
The starting point for RHIC was two meetings about patient safety and quality
improvement organised in collaboration with Institute for Healthcare Improvement
(IHI) and the Scottish Patient Safety Programme. The meetings were located at
the University of Stirling and the University of Dundee in 2010. Both meetings
were attended by >100 students and staff from across Scotland and the
audiences were enthusiastic for regular meetings to be held twice per year.
Attendees from these meetings decided on the name RHIC and the University of
St Andrews agreed to host the first RHIC meeting in November 2010. RHIC 8
was held in Edinburgh in May 2014, with RHIC 9 to be held at Robert Gordon
University on 29 October 2014 and RHIC 10 at University of West of Scotland in
March 2015.
Professor Tara Fenwick is a confirmed key note speaker for RHIC 9. Workshops
are to include:
Human Factors: Solutions to Clutter, Distractions and Interruptions
Perspectives on Student and Patient Voices
Safe to Learn: Simulation and Reality in the Workplace
RHIC meeting announcements and registration can be found on the QI Hub
website.
RHIC Action Plan for October 2014 - September 2015
All of the RHIC meetings have been attended by over 100 students and faculty
so there is clearly an appetite for sharing experience. However, relying on the
enthusiasm of another University to host the next meeting is not sustainable.
RHIC needs to form links with other networks for inter-professional education,
such as the Clinical Skills Managed Educational Network.
The Universities of Dundee, Stirling and West of Scotland have made significant
progress with supporting students and Early Career Professionals (ECPs) to
undertake successful Quality Improvement projects on placements in five Health
Boards. RHIC’s Action Plan for the next year will focus on three issues:
Certification
For students: completion of courses and progression of learning
For staff: progress of learning, linking to revalidation; identifying any other
incentives for certification, including opportunities for protected time
Board Buy-In
Permission for students and ECPs to do QI projects
‘Real’ engagement: e.g. contributing to the annual report of the Board
Improvement and Quality Committee (or equivalent) and/or evaluation of
return on investment by NHS organisations.
Communication strategy
What do students want?
One stop shop for students and ECPs together
Own page: Podcasts, video linked to face book, Twitter
What students are working on, showcased before projects are completed
Problem solving, e.g. Access to data (e.g. case notes) and overcoming
staff time constraints.
Faculty area with cumulative reports, e.g. of evidence that students and
ECP projects achieve sustained improvement
Recommendations
Please find time in your busy agendas to attend RHIC meetings over the next
year and to present posters about your work.
RHIC url
RHIC page on the QI Hub http://www.qihub.scot.nhs.uk/safe/reducing-harmimproving-care.aspx
Serious Games: Who needs them?
Answer yes to any of the following questions then this article is for you.

Are you a first responder?

Are you a maternity care provider?

Are you a health professional working in remote and rural practice?

Are your neonatal resuscitation skills rusty?

Interested in an imaginative and new ways to learn? If so read on.
At birth most babies breathe spontaneously without any help whilst others need
skilled help quickly. Predicting which babies will require help is not always easy,
so all maternity professionals caring for pregnant women require to be proficient
in basic neonatal resuscitation techniques. Not all births, however, can have a
maternity care professional present as babies arrive early, unexpectedly,
anytime, any place, thus requiring other health care disciplines to respond to
pregnancy related emergencies, needing these same neonatal resuscitation
skills.
The Scottish Multiprofessional Maternity Development Programme provides face
to face interactive training in neonatal resuscitation for all health professionals
who may be involved in providing care to pregnant women and their babies.
Once learned however, it’s not always easy to keep these essential but rarely
used clinical skills; it is known that knowledge and skills deteriorate rapidly if they
are not regularly practised. This is particularly challenging for remote and rural
teams who have to maintain a broad range of skills.
So how can we engage and motivate clinicians to retain their previously learned
neonatal resuscitation skills? The answer could be by using technology and
serious games.
Mobile technology is everywhere, you can’t walk down the street without seeing
people talking on their phones, accessing the internet and playing games on their
tablets. Mobile technology is also a platform for learning that can take place
anywhere at a time convenient to the user. With this in mind, we have developed
a serious game for neonatal resuscitation, a game with a purpose, a game that
can be picked up and played lasting only a few minutes whilst travelling on a bus
or train, sitting in a coffee shop, that can be stopped if you have to rush off.
The game has a variety of simulated scenarios that mimic real life but can be
practised in a safe simulated clinical environment. The game reinforces the
messages taught in the neonatal resuscitation practical course. Serious gaming
is a relatively new discipline with increasing evidence that it can be a useful tool,
that couples learning design with games features such as leader boards, in-game
hints etc. The aim of this game is to engage and motivate users to practise
resuscitation an engaging manner, transforming the learning experience whilst
supporting the maintenance of previously taught skills.
New and previous candidates on the neonatal resuscitation course get online
access free, contact us on how. Want to download it onto your mobile device?
It’s available both on apple and android formats at a small cost of £2.99 (allowing
us to manage the app and develop new scenarios, keeping users engaged)
Interested? Try it now and keep up to date; register at
www.neonatalresus.org.uk
Choose your user name and password then have fun.
Require more information? Contact helene.marshall@nes.scot.nhs.uk
Scottish Heath and Social Care Team Challenge – effective but fun!
At a recent human factors conference we were told by Debbie Rosenorn-Lanng
that learning should and could be fun! The Scottish Health and Social Care
Team Challenge in March 2014 certainly was that – hard work, thought
provoking, intense but a lot of fun!
This was a pilot of an interprofessional educational opportunity using
methodology developed over 10 years in Australia. Four groups of preregistration health and social care students competed for the inaugural title of
SHSCTC Winners, working virtually to prepare a care plan for an older person
with dementia – Mrs McTaggart. The teams comprised a mix of students from
speech and language therapy, nursing, medicine, physiotherapy, radiography,
social work, occupational therapy, pharmacy, applied biomedical sciences and
podiatry who, over a 4 week period, developed their skills in understanding and
treating dementia and understanding the roles of each other. The use of IT to
communicate and share ideas prepares them for the digital era and supports
their remote and rural practice. The students were provided with practice expert
mentors that they were able to contact a maximum of three times per mentor.
These mentors also included a carer of a person with dementia supported by
Alzheimer Scotland, who also contributed to the development of the scenario and
extension questions.
The event was very fast! The teams had five minutes to present their case plan
and a further three minutes to plan and present back their answers to extension
questions. A panel of expert judges including Scottish Government, Alzheimer
Scotland, Centre for the Advancement of Interprofessional Education (CAIPE)
and West of Scotland University Dementia Hub representatives observed the
teams in action and presented detailed feedback and scores for each team. The
winning team highlighted “evidence of effective team working, involvement of the
carer and demonstrated person centred care. There was evidence of deep
insight into IPE and very creative interventions”.
This winning team was then successful in securing funding from their universities
(Robert Gordon, Strathclyde and Glasgow Caledonian) and attended the All
Together Better Health VII International Interprofessional Bi-annual Conference
along with many of the SHSCTC project team. A paper and a poster were
presented with the students highlighting their learning to an international
audience and were inspirational! Jenny Miller comments “I felt so proud to be
connected to them. They were involved in both the paper and the poster and
all of them contributed to both in such a professional, enthusiastic,
refreshingly positive way. They articulated their learning so eloquently and
inspired their audiences. They had obviously enjoyed the challenge of the Health
and Social Care Team Challenge and learnt so much; every time they spoke I
learnt something new about their learning! “
Finally although small scale the evaluations were positive
STUDENTSLEARNING
The Interprofessional Socialization and Valuing Scale (King, G., Shaw, L., Orchard, C. A., and Miller, S. (2010))
7
6.8
1 = Disagree
7 = Very strongly agree
6.6
Scottish median
response before
Scottish median
response after
6.4
6.2
6
5.8
5.6
5.4
5.2
Median response
5
I feel confident in
I have gained a
I have gained an
I have gained an
I have a better
I have gained an
I have gained
taking on different
better
enhanced
enhanced
appreciation for
enhanced
greater
roles in a team (i.e. understanding of awareness of my
perception of the value in sharing awareness of roles appreciation of the
leader, participant) my own apporach own role within a myself as someone research evidence
of other
importance of a
to care within an
team
who engages in
across different professionals in a
team approach
interprofessional
interprofessional health professional
team
team
practice
disciplines in a
team
Question
Key feedback included:

When we met on the morning of the event to go over everything, it
felt more like a multi-disciplinary team situation that would happen
in practice.

I have developed more knowledge on dementia care from an MDT
aspect, improved communication regarding my role, communicating
online and using google docs and performing under pressure.

The greatest impact on my professional development was the
clarifying of professional roles and help and schemes available to
make the care patient centred.

Improved my communication skills, teamwork, quick thinking. I also
learnt that the patient and their family needs to be consulted and
considered in the decision process
Jenny Miller
NES AHP Practice Education Programme Lead on behalf of the SHSCT project
group
Jenny.miller@nes.scot.nhs.uk
South & East Regional Events
2nd October 2014
Chancellor’s Building Little France
Edinburgh
Two really exciting CS MEN events in Edinburgh. One will be an interactive
workshop in the morning by Bryan Allan on managing students with
communication difficulties. The other, in the afternoon, will be a showcase of
presentations and discussion on 'improving the student experience. Both events
are free and all are welcome to attend. To book a place, please complete
registration form (http://www.csmen.scot.nhs.uk/news/cs-men-regional-event-2october-2014.aspx) then email to csmen@nes.scot.nhs.uk. Final programme to
follow.
South and East Consortia
From Janet Skinner
One of the hot topics in clinical skills at the moment is chest drains. This resulted
after a few adverse incidents, leading to calls for formal mandatory training
programmes in chest drain insertion. In Lothian we are working on including
chest drains in James Tiernan's Skills Mastery Programme and introducing a
chest drain scenario into our ED simulation in situ 'resus Friday' programme. For
anyone that is interested here is a link to CS MEN's chest drain pack which is
freely available for all to use on the NHS shared e-learning website
http://elearning.scot.nhs.uk:8080/intralibrary/IntraLibrary?command=openpreview&learning_object_key=i287n2751048t
Contact me at: janet.skinner@ed.ac.uk
West Consortia
From Anna O’Neill
I attended the CS MEN R&D Conference 2014 is Stirling in June. This was a
highly successful event and showcased the CS MEN funded research. There
was a tremendous variety of research into Human Factors and this was an
excellent networking opportunity. The Conference demonstrated the current
national activity and there were highly constructive round table discussions on
the day.
We are looking forward to having the Mobile Skills Unit at the Southern General
Hospital from 27 October- 7 November.
Email: anna.oneill@glasgow.ac.uk
North Consortia
From Jerry Morse
Well that is the summer over and here we are back at the beginning of a new
academic year with all the clinical skills provision that this brings with it. I hope
that those who managed to get away feel suitably refreshed and ready for the
challenges of a new session.
As I said in the last Newsletter, I think that it is important that as a region we get
together and have a meeting so that we can prioritise what workshops and
educational resources you, as the members, would like CS MEN to provide. I
have some provisional dates identified for both the meeting and the workshops
and once the venues, which I would like to be across the region, have been
confirmed, we will send an email letting you all know.
In October the MSU will be visiting Elgin and Nairn. Unfortunately I cannot be
there for the Elgin visit, I do look forward to supporting the Unit when it is in Nairn
- meeting with local educators from both the in and pre-hospital sectors to
develop the delivery of clinical skills across the region.
Email: jerry.morse@abdn.ac.uk
Contact
tel: 01382 425735
e-mail: csmen@nes.scot.nhs.uk
web: www.csmen.scot.nhs.uk
© NHS Education for Scotland 2014. You can copy or reproduce the information
in this document for use within NHSScotland and for non-commercial educational
purposes. Use of this document for commercial purposes is permitted only with
the written permission of NES.