Martin, Anne Andrew

Mugford, Bruce V

Owen, Harry

English

Flinders Academic Commons

Archived at the Flinders Academic Commons:  http://dspace.flinders.edu.au/dspace/  This is the publisher’s copyrighted version of this article.  The original can be found at: http://www.racgp.org.au/afp/200404/20040413mugford.pdf © 2004 Australian Family Physician www.afp.org.au Copyright to Australian Family Physician. Reproduced with permission. Permission to reproduce must be sought from the publisher, The Royal Australian College of General Practitioners. Reprinted from Australian Family Physician Vol. 33, No. 4, April 2004279Twelve months of hospital training is acomponent of Australian general practicetraining. Its purpose is to provide registrarswith additional clinical experience and toallow them to reflect on how hospital caremay relate to general practice.1 The challengeto providers of primary care training in thishospital period is to ensure that the skillsbeing taught are relevant to primary care, andthat registrars undertake a meaningful transi-tion to the primary care environment.2,3Sturt Fleurieu General Practice Educationand Training (SFGPET) introduced an emer-gency medicine course using a fullycomputerised human patient simulator in 2002.Human patient simulators are used to create arange of clinical scenarios for teaching pur-poses in several acute disciplines,4,5 but rarelyspecifically for general practice. The programwas developed by experienced general practi-tioners in collaboration with the staff of anestablished simulation facility. The clinical sce-narios were designed around general practiceemergency situations. Debriefing sessionswere primarily managed by GPs with inputfrom specialists. Session themes of: acute coma, cardiacemergencies, airway management, paediatricresuscitation, and trauma were selected on thebasis of ‘critical incident’ reporting by registrarsin their basic training terms,2 the experience ofGPs themselves,6 and The Royal AustralianCollege of General Practitioners’ emergencymedicine curriculum.7Program structureNine hospital based SFGPET registrars partic-ipated in 3 hour teaching sessions at theFlinders University Clinical Simulation Unit.The simulations were videotaped and therecording was reviewed with the participantsduring facilitated debriefing sessions. Program evaluationRegistrars evaluated each session with aquestionnaire that measured agreement withstatements about the scenario (using a 7-point Likert scale). An additional question-naire addressed skill (self assessed) and wasgiven to all registrars before and after thecourse. These skills were similar to thoseskills identified by GPs as being important6,8,9and the scores were compared using theWilcoxon matched pairs signed ranks test.ResultsRegistrars reported high levels of satisfaction.The simulator and the unit were considered sat-isfactory or very satisfactory by 80% ofparticipants, with clear or very clear scenarios(74%) and session objectives (83%). Registrarsagreed or strongly agreed that the feedback ses-sions were valuable (91%) and well managed(91%) and in particular agreed or strongly agreedthat the follow on skill sessions were valuable(96%); although only 60% agreed or stronglyagreed that the simulator was realistic. Open responses by registrars endorsedthis: they reported having ‘sweaty hands - must have been realistic’ as well as findingthe experience ‘a bit nerve wracking before-hand’ but also acknowledged that this was‘not necessarily a bad thing’. The feedbacksessions afforded the ‘opportunity to discusswith more experienced doctors their experi-ence’. Significant improvement in selfassessed emergency medicine skills wasfound in most registrar scores (Table 1). DiscussionThe increasing sophistication of human patientsimulators may provide an opportunity tobegin to address primary care training deficien-cies within hospitals. Our experience suggeststhat simulation is useful as it does not rely onclinical opportunity to learn and rehearse theskills needed in emergency situations. Thecentral role of experienced GPs in the debrief-ing sessions is also important because itprovides registrars with a general practice per-formance benchmark and introduces seniorGPs as clinical role models from the timegeneral practice training commences. Clinical simulation is expensive and furtherobjective assessment learning of clinical skillsand competence through simulation as ameans of bridging the hospital divide needsto be undertaken. Nevertheless we found asignificant increase in the confidence of reg-istrars in their emergency skills. Simulation training in emergency medicineAn important need for primary care trainingBruce Mugford, BM, BS, FRACGP, MPH&TM, is Director, Sturt Fleurieu General Practice Education and Training, South Australia.Anne Martin, PhD, is Education Coordinator, Sturt Fleurieu General Practice Education and Training, South Australia.Harry Owen, MB, BCh, MD, FRCA, FANZCA, is Professor in Anaesthesia and Intensive Care, and Director, Clinical Simulation Unit,Flinders University and Flinders Medical Centre, South Australia.RESEARCH• Computer simulations based aroundgeneral practice and led by experi-enced GPs may overcome thedeficiency in general practice exposureand training for hospital doctors. • Computer simulations increase confi-dence in emergency skills for registrars.Implications of this study for general practiceConflict of interest: none declared.References1. Australian General Practice Training Handbook.Canberra: General Practice Education andTraining, 2002.2. Diamond M, Kamien M, Sim M, Davis J. A criti-cal incident study of general practice trainees intheir basic training term. Med J Aust1995;162:321–324.3. Sim M, Kamien M, Diamond M. From novice toproficient general practitioner: a critical incidentstudy. Aust Fam Physician 1996;25(Suppl 2):59–64.4. Weller J, Bloch M, Young S, et al. Evaluation ofhigh fidelity patient simulator in assessment ofperformance of anaesthetists. Br J Anaes2003;90:43–47.5. O’Brien G, Haughton A, Flanagan B. Interns’perceptions of performance and confidence inparticipating in and managing simulated andcardiac arrest situations. Med Teacher2001;4:389–395.6. Tolhurst H, McMillan J, McInerney P,Bernasconi J. The emergency medicine trainingneeds of rural general practitioners. Aust J RuralHealth 1999;7:90–96.7. Training Program Curriculum (CurriculumStatement). 2nd edn. South Melbourne: RoyalAustralian College of General Practitioners, 1999. 8. Somers GT, Maxfield N, Drinkwater EJ. Generalpractitioner preparedness to respond to amedical disaster. Part 1: Skills and equipment.Aust Fam Physician 1999;28(Suppl 1):3–9.9. Somers GT, Maxfield N, Drinkwater EJ. Generalpractitioner preparedness to respond to amedical disaster. Part 2: Ability and training.Aust Fam Physician 1999;28(Suppl 1):10–14.280Reprinted from Australian Family Physician Vol. 33, No. 4, April 2004Research: Simulation training in emergency medicine: An important need for primary care trainingTable 1. Summary of registrar pre-and post-test results for emergency medicine skills identified in ‘emergency medicine skillself assessment questionnaire’Emergency medicine skill statement Mean Median SD Minimum Maximum p value Wilcoxon pre- and post-test comparison resultsSpeak calmly and effectively with Pre +0.8 1 +0.8 -1 2 NS patients in emergency situations  Post +1.4 2 +1.8 -2 3 Develop a management plan for  Pre +0.1 1 +1.2 -2 1 <0.01 emergency situations Post +1.4 2 +1.1 -1 3Manage an emergency situation  Pre +0.2 1 +1.5 -2 2 <0.05   in hospital   Post +1.7 2 +1.1 -1 3 Manage an emergency situation Pre -0.6 0 +1.3 -3 1 <0.01 in the community  Post +1.3 1 +1.0 0 3Recognise an emergency situation Pre +1.1 1 +1.5 -2 3 <0.01  Post +2.8 3 +0.4 2 3    Find help in an emergency  Pre +0.9 1 +1.3 -1 2 NS   Post +1.7 2 +0.9 0 3    Do a standard endotracheal intubation Pre -1.0 -1 +1.8 -3 1 <0.01 Post +1.8 2 +1.0 0 3    Manage a patient’s airway in an  Pre +0.6 1 +1.4 -2 2 <0.01    emergency situation    Post +2.3 2 +0.7 1 3Successfully use a laryngeal mask Pre -0.6 0 +1.7 -3 1 <0.01 Post +2.0 2 +1.1 0 3    Insert an oral airway Pre +0.6 1 +1.8 -3 2 <0.01   Post +2.4 3 +0.7 1 3   Assess the status of an emergency  Pre +0.6 1 +1.3 -2 2 <0.05 patient Post +2.3 2 +0.7 1 3Mask ventilate a patient Pre +0.7 1 +1.5 -2 3 <0.01Post +2.2 2 +0.7 1 3    Insert an intravenous line Pre +2.2 2 +1.0 0 3 <0.05   Post +2.3 2 +0.7 1 3    Give intravenous drugs Pre +2.0 2 +1.3 -1 3 <0.05 Post +2.7 3 +0.7 1 3    Give intramuscular drugs Pre +1.9 2 +1.3 -1 3 <0.05  Post +2.6 3 +0.9 1 3    Give subcutaneous drugs Pre +1.8 2 +1.3 -1 3 <0.05 Post +2.4 3 +1.1 0 3CorrespondenceEmail: bruce.mugford@flinders.edu.auAFP

Simulation training in emergency medicine. An
            important need for primary care training

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Simulation training in emergency medicine. An important need for primary care training

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