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Building upon the use of simulation to improve systems, as considered during last year’s conference The simulation community has been attentive to the issues raised and must not shy away from exploring deeper these underlying issues that may impair adequate care. Sensitive to this need, diversity and inclusion are the themes of this year’s Association for Simulated Practice in Healthcare (ASPiH) annual conference. Many abstract submissions show how these topics can be meaningfully incorporated within simulation activities, scenario design, debriefings, and are applicable to various simulation modalities But diversity and inclusion are also highly relevant with regards to our colleagues in the clinical setting as well as within our simulation circle. We need to consider our own educational community of practice by being role models in terms of diversity and inclusivity. We hope to see a very diverse and inclusive groups of delegates attending the 2022 ASPiH Conference in Birmingham, 6-8 Thank you to everyone who responded to the call for abstracts for this year’s ASPiH conference. Thank you also to all the reviewers involved in the selection process as we couldn’t run the conference without you. Now is the time to start thinking about your contribution for next year! 1. Moneypenny M, Weldon SM, Hamilton C, Buttery A, Alinier G. ASPiH 2021 Conference–Moving upstream: using simulation to improve systems. International Journal of Healthcare Simulation. 2022;1(1):1–2. 2. Lee P, Le Saux M, Siegel R, Goyal M, Chen C, Ma Y, Meltzer AC. Racial and ethnic disparities in the management of acute pain in US emergency departments: Meta-analysis and systematic review. The American journal of emergency medicine. 2019;37(9):1770–7. 3. Drabish K, Theeke LA. Health impact of stigma, discrimination, prejudice, and bias experienced by transgender people: a systematic review of quantitative studies. Issues in mental health nursing. 2022;43(2):111–8. 4. Knickle K, Weir K, McNaughton N. Authoring and othering: examining bias in scenario design. International Journal of Healthcare Simulation. 2021;1(1):45–8. 5. Bignell A, Baxey E, Saunders A, Ortega-Vega M. Reducing Restrictive Practices- Using simulation education to tackle mental health stigma. International Journal of Healthcare Simulation. 2022. doi: 10.54531/WCNV4657 (In this current special issue) 6. Welsh H, Clay G, Fisher M, Ortega-Vega M, Virk K, Evans G. The Power and Influence of the Theatre on Immersive 360° Videos. International Journal of Healthcare Simulation. 2022. doi: 10.54531/CRTF6001 (In this current special issue) 7. Wadsworth J, Blair J, Millett R, Damberg K, Esposito M, Van Vuren E, Marshall E. Using a systems-based approach to explore the enablers and barriers to equality, diversity, and inclusion within a simulation-based education service. International Journal of Healthcare Simulation. 2022. doi: 10.54531/INKE9149 (In this current special issue) 8. Paul O, Connor DB. Fostering diversity in healthcare simulation. International Journal of Healthcare Simulation. 2022 Jul 29(null):1–2. 9. Kulkarni S, Tsigerides J, Sule Medha. Walk in Their Shoes - Immersive 360-degree VR experience of Diversity and Inclusivity in the NHS. International Journal of Healthcare Simulation. 2022. doi: 10.54531/LADH8978 (In this current special issue) 10. FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Medical Ethics. 2017;18(1):1–8. 11. Vora S, Dahlen B, Adler M, Kessler DO, Jones VF, Kimble S, Calhoun A. Recommendations and guidelines for the use of simulation to address structural racism and implicit bias. Simulation in Healthcare. 2021;16(4):275–84.

Conducting child protection medical assessments (CPMA) where there are concerns of non-accidental injury (NAI) is a key clinical skill for paediatricians and part of the Royal College of Paediatrics and Child Health (RCPCH) curriculum [1]. Child Protection (CP) simulation training was commissioned following trainee feedback around unpreparedness when carrying out CPMA. The COVID-19 pandemic forced delivery of online CP simulation. Initial learners were paediatric trainees; with newly qualified school nursing and health visiting colleagues in subsequent delivery; allowing for multi-professional learning in the simulated environment. The session aims were to: - increase familiarity with professional conversations in the CP context - formulate an evidence-based opinion in cases of suspected NAI - rehearse discussing outcomes of CPMA with parents/carers and social workers We rehearsed, modified, and then, using Zoom as a synchronous platform, with a trained simulated patient (SP) and faculty as role players created three 10-minute community-based CP scenarios for a twice-yearly programme. Pre-course information and a pre-briefing explained the online limitations and opportunities, including how we co-create psychological safety, the option of a wellbeing ‘wobble’ room, also outlining the Diamond debriefing model [2]. Pre- and post-course surveys were sent to the 18 participants. Likert scale ratings on confidence and anxiety levels when approaching a CP medical; familiarity with and likelihood of using the HEADSSS tool [3] was analysed using paired T-test probability. 94% (17/18) had no previous CP simulation experience. Confidence in carrying out CPMA increased post-simulation (p= 0.00418) Anxiety going into the CPMA decreased post-simulation (p=0.00624). 44% were familiar with HEADSSS tool pre-course and 94% were more likely to use it post-course (Likert rating 4or5). Confidence in expressing concerns to parent/carer rose from 11% to 82.3% post-course (Likert rating 4or5). Free text learning points included ‘Use what you can agree on (parent and doctor) as a foundation for developing rapport.’ ‘… very useful in preparation for community.’ ‘… very helpful in giving me more confidence in carrying out medicals.’ ‘Never undertaken a simulation with an actor, it felt real (I was surprised)’, ‘interesting to share learning… as practitioners have different perspectives.’ Despite sensitivity of the subject and the emotive realism brought by the SP’s, psychological safety was achieved in this online interprofessional CP simulation training through detailed preparation in course design and faculty preparedness. The pilot was successful in preparing participants to fulfil their safeguarding role. Online training continues to be a synchronous induction for 2022. 1. RCPCH. Progress curriculum. Royal College of Paediatrics and Child Health 2018. 2. Jaye P, Thomas L, Reedy G. The Diamond: a structure for simulation debrief. The Clinical Teacher. 2015; 12(3):171–175. 3. Cohen E, Mackenzie RG, Yates GL. HEADSS, a psychosocial risk assessment instrument: implications for designing effective intervention programs for runaway youth. Journal of Adolescent Health. 1991;12(7):539–44.

Human factors are essential to patient and staff safety, particularly during the COVID-19 pandemic with redeployment of staff to different roles in unfamiliar environments The aim of the study was to ascertain the efficacy of converting face-to-face simulation and debriefing into online asynchronous video-based scenarios and debriefing, to enhance understanding of human factors skills.In October 2020, a half-day simulation course commenced. Due to suspension of face-to-face teaching in December 2020 with COVID-19 cases rising, this was converted into a half-day online format through filming faculty participating in the existing scenarios. These films were shown to participants, followed by asynchronous online debriefing via Microsoft Teams. Both formats had e-learning as a pre-requisite. Data were collected using pre- and post-session questionnaires containing the Human Factors Skills for Healthcare Instrument (HuFSHI) Post-training, staff demonstrated improvement in self-efficacy of human factors skills for healthcare. There was no statistical significance between mean improvements for both formats; the greatest improvement was split equally (Table 1). 100% found the face-to-face (N = 24) useful, versus 98% online (N = 54). Communication was the skill most learnt (face-to-face 58%, online 65%), with teamwork (face-to-face 50%, online 48%), escalation (face-to-face 42%, online 57%) and self-care (face-to-face 38%, online 19%) also frequently mentioned. Aspect’s learners’ thought were good included the discussion-based element (face-to-face 50%, online 37%), interactivity (face-to-face 13%, online 31%), multi-disciplinary team involvement (face-to-face 13%, online 20%) and videos for the online format (19%). 21% wanted the face-to-face longer, 15% wanted the online shorter. 9% would rather the online was face-to-face.Online asynchronous debriefing produced similar outcomes to face-to-face for teaching human factors. We posit that this was because the videos were not ‘best practice’ – thus stimulating learning conversations, which accessed learners’ frames and past experiences. Challenges for faculty included: pace and volume of sessions, managing psychological safety, emotive discussions, screen fatigue, and technical aspects. A 6-month follow-up survey is planned and will be included in the presentation. Further work is required to understand why the results were similar.

In the UK, 10% of trainee doctors are out of clinical practice at any given time, for reasons including personal health, carer duties, further education, research and parental leave.1 Doctors report that leaving work often invokes feelings of isolation and sadness, as well as concerns around a lack of support from colleagues and organisations, and even negative views from their families.1 Self-stigmatisation sees doctors internalise negative views about themselves, promoting self-esteem issues and a lack of help-seeking behaviour, which also relates to the constructs of personal and professional identity.2 Addressing and tackling the barriers related to returning to work is not only beneficial for a doctor’s well-being but for patient care too. One systematic review found that doctors with higher occupational well-being adhere more to treatment guidelines, are more optimistic and helpful, and direct more attention to patient’s psychosocial health.3 Although programmes exist to support returning doctors, there is a shortage of evidence-based interventions. This report outlines a training intervention and subsequent evaluation for returning healthcare professionals, in which they can develop their clinical skills and needs as well as their own psychosocial skills and needs. ### Training course The 4-day course aimed to update doctors returning to work on their clinical skills and knowledge, while creating an open space to address personal and psychosocial needs regarding returning (see table 1 for learning activities and scenarios). The course was delivered in a simulation centre in South London, with each day lasting approximately 8 hours, by a multiprofessional faculty of clinical educators and simulation experts, including doctors, nurses and …

The COVID-19 pandemic worldwide has led to the establishment of a large number of field hospitals created to facilitate emergency intensive care facilities outside the routine hospital setting notably created in the USA, India and China. The Nightingale Hospital arose within a conference centre in London with an initial capacity of 500 ventilated beds and potentially 4000 patients in total based on initial forecasts. As part of the Nightingale Hospital, we faced the challenge of overseeing potential management of ventilated tracheostomy patients within this unique field hospital setting. Given the potential morbidity associated with tracheostomy care and specific care needs, a key …

Objective To assess the utility and frequency of use of the Nightingale Communication Method, during the early operational phase of the Nightingale Hospital London (NHL) 4000-bed field hospital’s intensive care unit. Design Survey-based cross-sectional assessment. Setting The intensive care unit at the Nightingale London hospital. Participants Staff working in the clinical area and therefore requiring full personal protective equipment (PPE). Intervention Survey of all staff members sampled from a single shift at the Nightingale Hospital. This investigated perceived utility and actual use of identification methods (name and role labels on visors and gowns, coloured role identification tapes) and formal hand signals as an adjunctive communication method. Main Outcome Measure Self-reported frequency of use and perceived utility of each communication and personnel identification adjunct. Results Fifty valid responses were received (72% response rate), covering all clinical professional groups. Prominent name/role identifications and coloured role identification tapes were very frequently used and were perceived as being highly useful. Formal hand signals were infrequently used and not perceived as being beneficial, with respondents citing use of individual hand signals only in specific circumstances. Conclusion PPE is highly depersonalizing, and interpersonal identification aids are very useful. Despite being difficult, verbal communication is not completely prohibited, which could explain the low utility of formal hand signals. The methods developed at the Nightingale hospital have enhanced communication in the critical care, field hospital setting. There is potential for wider application to a variety of healthcare settings, in both the current situation and future pandemic scenarios.

Introduction NHS Nightingale London provided a critical care environment for creating capacity within the healthcare system. An education faculty designed & delivered a curriculum with the aim of equipping the workforce with the skills to work within NHS Nightingale at the Excel. NHS Nightingale presented unique challenges, including unfamiliar working practices, equipment & team membership variables, whilst working in a large and noisy environment, originally built as an exhibition centre 1. Simulation is an education modality that is employed to produce a safe experience to help prepare learners for a future real event 2. A 12 bed high-fidelity simulation facility was set up in The O2 Arena to replicate clinical reality for what will be anticipated within NHS Nightingale. Providing mass scale simulation in an arena provided many complexities which were confounded by the emergent situation of having to rapidly increase ICU provision due to COVID-19 pandemic. Methods A simulation ward was built on the arena floor, aiming to provide clinical simulation for staff working at NHS Nightingale. We had 5 days to design and implement a simulation curriculum with limited kit availability. The large and acoustically challenging arena with no privacy, as well as social distancing, made it difficult to communicate and facilitate debriefs. Due to NHS surge plans already being activated, there was limited adult critical care educators, which created variability with the faculties expertise in simulation and critical care. There was variance in the learners which included both experienced & non-experienced critical care staff, through too volunteers with no health care background. Results In total 2732 learners went through the education curriculum which involved a large component of simulation education. The curriculum was positively evaluated by learners. Discussion The faculty adopted a co-facilitation, adaptive approach to support simulation and debriefing. Daily pre-briefing and debriefing allowed iterative adaptation of the programme and supported faculty development. Social distancing was maintained by limiting participants per scenario, providing short simulation sessions and distancing during debrief. The plus/delta debrief model was used as this provides a swift debrief whilst also allowing novice and experts to debrief to successful outcomes 3. Scenarios with differentiated learning outcomes were matched to the streamed groups depending on their expertise and where applicable benchmarked to national competencies 4. Conclusion A large and skilled faculty, creative and adaptive to varying learner needs using a rapid improvement framework ensured that large scale simulation could be implemented within an arena. Reference Collins T, Laws-Chapman C & Houslip L ( 2020) Reflection on NHS Nightingale London. Resuscitation Today. 7:10–12. https://www.resustoday.com/view-latest-issue/ Gaba D ( 2004) The future vision of simulation in health care. Qual Saf Health Care13:i2–10. Schertzer K, Patti L. In Situ Debriefing in Medical Simulation. [Updated 2019 Oct 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; [Accessed 06/06/2020] Critical Care Network National Nurse Leads (CC3N) (2015) ‘National Competency Framework for Registered Nurses in Adult Critical Care . Step 1 competencies’.

Background Unlike obstetrics, simulation within gynaecology has been limited to endoscopy training for specialty doctors and trust training for nurses and nursing assistants. This warrants urgent attention as inpatient gynaecological care is increasingly complex. Collaborative practice in managing these cases is essential for patient safety. It is crucial that specialty professionals have awareness of medical complications and can continue to recognise medical emergencies early. Gynaecology has lagged behind nurse and medical training in developing strategies to improve human factor training. Summary of project Medical emergencies in gynaecology (MEG) course is the first gynaecology human factor simulation course developed by interprofessional multidisciplinary stakeholders. Ideas were pooled from a multi-professional course development questionnaire regarding staff experience, confidence and incident reviews. Rapid improvement cycles (PDSA) resulted in pilot and implementation phases. High fidelity scenarios were generated within the framework of the diamond debrief model¹ based on medically intricate inpatient emergencies. Scenarios focused on human factors in managing cases outside the scope of routine practice development in areas of lowest confidence. These included electrolyte disturbance, renal failure, massive pulmonary embolism, and end-of-life management. The impact of the course was assessed through pre and post-course questionnaires. Summary of results Preliminary data from delegates and faculty was overwhelmingly positive. 37.5% of responders were registrars, 12.5% senior house officers, 25% senior nurses and 25% staff nurses. The participant skill mix was deemed by 88.9% of questionnaire responders as good or excellent. Pre-course, 50% and 37.5% of responders reported feeling nervous or anxious respectively. Subsequently, all responders felt either knowledgeable, enthusiastic or motivated. 88.9% of responders valued interprofessional multidisciplinary debriefing of issues including: leadership, culture, situational awareness, decision-making and communication. All participants agreed emphasis on collaborative practice was invaluable in improving patient outcomes. Furthermore, a participant has now undergone faculty training. Discussion, conclusions and recommendations Tackling myths of human factor understanding with simulation training is a novel approach to improve team working within inpatient gynaecology. The Royal College of Obstetricians and Gynaecologists supports this expanding area of non-technical skills to improve patient safety but there is currently little formal training or assessment². We intend to expand the MEG course into a permanently embedded program. In the future, gynaecology outpatient scenarios will increase the acceptability of this course to outpatient professionals. On reflection, this is a powerful modality with the benefit of unifying the interprofessional team and championing collaborative practice. References Jaye, P., Thomas, L., Reedy, G., 2015. ‘The Diamond’: a structure for simulation debrief. The clinical teacher, 12(3), pp.171–175. Jackson, K.S., Hayes, K., Hinshaw, K., 2013. The relevance of non-technical skills in obstetrics and gynaecology. The Obstetrician & Gynaecologist, 15(4), pp.269–274.

Workshop In-situ simulation is fast becoming the panacea of Simulation Based Education (SBE). In-situ simulation is used because it can produce highly realistic training with opportunities for team and systems testing while remaining embedded in the clinical setting. With a diversity of theoretical underpinnings, there is limited evidence in the public domain as to what practical procedures can enhance safety in the design and delivery of SBE in the clinical workplace. Especially significant risks include disruption of service and more importantly, physical safety for patients and staff. Basic safeguarding procedures in place at a large London teaching hospital, including a traffic light checklist and a system to sign equipment in and out, seem to have prevented any errors resulting in harm. However, the possibility of simulation-related mishaps resulting in patient, participant, or staff, harm is real and significant. Despite clear procedures and standards being in place, other seemingly less dangerous errors have been reported: a simulated blood gas syringe and lab result being left in a clinical area, a simulated handover sheet and used defib pads on a resuscitation trolley, an unused shock box for defibrillation. In addition, annual staff turnover means institutional memory—knowledge of our incidents and safeguarding principles (checklists)—have been lost in handover and information transfer. A recent podcast on Simulcast http://simulationpodcast.com/simulcast-journal-club-february-2019/ inspired our centre to review its practice. This workshop aims to discuss the core components of SBE safety standards, both from the national, international and locally applied perspectives from the authors place of work. From there the workshop will act as a focus group to discuss common practices with the purpose of surfacing best practice that may contribute to the beginnings of a consensus for future guidelines. It is aimed at Introductory, Intermediate and Expert educators working in the simulation community. Intended learning outcomes Present the reasoning underpinning the principles of making in–situ simulation practice safe List the core components that ensure simulation safety for in–situ (and lab–based) simulation Identify the different approaches undertaken in healthcare simulation to ensure patients & staff do not come to harm Create the beginnings of a consensus for practice to be considered as part of the National Standards Framework Timeline: Minutes 0–5 Workshop introduction Minutes 05–20 Overview of existing standards Minutes 20–40 Group Discussion: core components of approaches Minutes 40–55 consensus for practice Minutes 55–60 Summary & close Methods Didactic introudction with visual aids, group work and nominal group technique.

Introduction Currently available HCID-A patient transfer guidelines do not include reference to managing mobile ECMO support for severe respiratory failure¹. ECMO significantly increases the complexity of transfer in critically ill patients, whilst HCID-A pathogens present a novel UK risk. Guys and St Thomas’ NHS Trust (GSTT) is the newly commissioned national network lead for HCID-A, and an established ECMO centre. Our team recognised the requirement for development of new guidance to ensure safe transfer of critically ill HCID-A patients, including those requiring ECMO, without compromising quality of care or safety of staff and the general public. Methods We developed a prototype patient transfer procedure for a critically ill HCID-A patient, based on existing protocols for Ebola and mobile ECMO. This was then evaluated using an in situ simulation to test protocol performance and look for latent threats². A detailed plan and timetable were disseminated to the extensive multi-disciplinary team (MDT) involved; including intensive care, infectious diseases, infection control, emergency department, site managers, security and CT radiographers. We also undertook prior training in HCID-A personal protective equipment (PPE). The simulation was initiated by text message alert along GSTT major incident activation lines, leading to the teams gathering for a briefing. A patient simulator was transferred from ambulance, through CT scanning and then to the intensive care isolation facility. Simulation took place in ‘real time’ and, following its completion, there was a hot debrief of the entire MDT. Audio-visual and qualitative data were recorded throughout. Results Learning points from the simulation and debrief were incorporated into an HCID-A standard operating procedure (SOP) for GSTT. These included the safest transfer route through the hospital (minimising impact on the emergency department), methods for lift and corridor ‘lockdown’, clarity on team size and responsibilities, and development of a CT scan guideline. In addition, we were able to evaluate the safety and usability of our HCID-A PPE, which led to protocol changes. Discussion The transfer of an HCID-A ECMO patient is an unusual, complex and high-risk scenario and our simulation successfully tested our institution’s ability to respond to this. This was facilitated by careful prior planning and engagement of the MDT. Our experience was that in situ simulation was essential in development of a safe HCID-A SOP. Our intention is to continuously re-evaluate our protocols using simulation, in order to maintain maximum safety and best practice. References Public Health England (2018) Investigation and public health management of possible cases of Middle East respiratory syndrome coronavirus (MERS-CoV)v31 Patterson M, et al. In Situ Simulation: Challenges and Results. In: Henriksen, et al. Advances in Patient Safety: New Directions and Alternative Approaches (Volume 3: Performance and Tools). Rockville, 2008

Introduction and aims An Acute Hospital Trust and Mental Health Trust, worked collaboratively to design and deliver a four-day course for multi-professionals who were planning to return to work after a period of absence of greater than three months. We will explore the collaborative process, what we expected learners requirements were from the scoping exercise, and how these differed from real life expectations. The evaluation of the course demonstrated that a greater weight was placed on pastoral needs by participants than was anticipated. We aim to discuss how the utilisation of each Centre’s expertise and the extended length of the course contributed to enhanced psychological safety, and succeeded in developing the confidence, wellbeing and skills of healthcare professionals from multiple disciplines and specialties. Learning objectives This workshop aims to generate a creative and interactive environment in which participants will achieve the following: Explore the perceived needs of those returning to healthcare employment after a period of absence Explore how collaboration can be achieved between centres and disciplines Learn about what the experience of returning to work entailed and felt like to a returner, including how this course contributed to their successful return Discuss and share experiential learning opportunities outside of traditional simulation scenarios Session description A brief didactic introduction will be used to introduce the context and content of the session. This will be followed by breaking up into facilitated focus groups to explore perceptions of the needs of those returning to work in healthcare. Participants will then hear from a returnee who will discuss their own needs and how the course contributed to the success of their return. Video footage will be presented to demonstrate how the strengths of each simulation centre were utilised to provide a high fidelity backdrop to a comprehensive patient journey. Time will be built in at the end of the workshop for response to participant questions. Educational methods There will be combination of facilitated group work to stimulate creative thinking around this topic, video presentations, service user perspective, and traditional didactic presentation. Target audience The session is designed for all simulation staff References Jenny W. Rudolph, PhD; Daniel B. Raemer, PhD; Robert Simon, EdD. Establishing a Safe Container for Learning in Simulation The Role of the Presimulation Briefing. Sim Healthcare 2014; 9:339–349.

This year sees the 10th anniversary of the Association for Simulated Practice in Healthcare (ASPiH, www.aspih.org.uk), and close collaboration with the Irish Association of Simulation (IAS) and the Northern Ireland Simulation and Human Factors Network will deliver a fitting celebration of this milestone at the annual conference in Belfast. Much has changed in 10 years and simulation-based education (SBE) is now accepted in the UK and worldwide as an integral part of the armamentarium of an educator in healthcare. It is helpful that SBE is championed by educators, academics and commissioners,1–3 but it is now supported by a robust evidence base which reveals the effectiveness of experiential learning incorporating simulation for both technical4 and non-technical skills.5 This editorial will review progress in SBE in the UK over this decade through the lens of our national association’s development and future aspirations. ASPiH’s mission is to “promote and support simulation based education and technology enhanced learning (TEL) in the pursuit of best practice for our patients, learners and partners”.6 Underpinning this mission are aims which focus on delivery of effective communication networks; providing a resource for expertise in SBE and TEL; supporting expansion of SBE; sharing resources and encouraging research and innovative practice. The question is have we achieved those aims in the past 10 years? In order to facilitate ASPiH’s mission, an understanding of the scale and variety of SBE in the UK was necessary and the National Simulation Development Project7 was devised with the support of Health Education England (HEE) and the Higher Education Authority. This scoping exercise was undertaken between 2011 and 2012, 2 years after ASPiH’s founding, and revealed several important challenges including the need for improved networks in SBE; better support and development for faculty and the requirement for standards …

The NHS continues to face challenges on many fronts in terms of planning and delivering high quality health and social care across hospital and community-based services. The reasons are multifaceted, but contributory issues include an ageing population who present with a mixture of acute and long-term conditions that require more complex or specialist management; significant public health concerns arising from dietary and alcohol related problems combined with a relatively sedentary lifestyle amongst the population; alterations in patients’, public and political expectations of the health and social care services in terms of accessibility, efficiency and effectiveness of care; scientific advances in options for care along with IT and technological innovations that seem to outstrip the ability of the service to implement changes at a pace that enables benefits to be evaluated whilst providing sufficient time and rigour to detect and manage any associated but unforeseen problems. The result is a picture of increasing financial, time and other resource pressures across all aspects of the NHS, whether in terms of delivering care or supporting the education and training of the current and future workforce. When faced with this somewhat challenging outlook, how might the simulation community seek to respond? The answer lies in taking a broader view at how the health and social care system is being asked to adapt to these conditions both strategically and in operational terms. This should enable recalibration of how, when and where the use of highquality simulation-based interventions or programmes will contribute to potential solutions in local contexts or enhance national policy-level responses to address wider service needs. Prime examples of such an analysis concerns how simulation can support key policy initiatives such as workforce transformation, return-to-work programmes, and the emergence of new curricula for health care professions, each of which are seeking to be …

Background Simulation is perceived as an expensive training modality and therefore the efficiency of the training day is important. A significant proportion of a simulation training day is spent familiarising participants with the simulation environment, educational approach and setting out expectations for the day. This is an important step as it assists with the psychological safety of participants. However, this leaves less time for simulation and debriefing, which can potentially have a detrimental impact on the quality of the training being delivered, and the educational outcomes for participants. In an attempt to improve the efficiency of simulation training, we have developed an innovative multi-layered interactive e-learning program has been developed to compliment simulation based education across a variety of Health Science Centres. Study aim We hypothesise that this e learning package will result in1 reduced participant anxiety prior to training2 faculty spending more time debriefing and3 Improved learning outcomes for participants. Methods Using a quasi-experimental design anxiety, debriefing time and learning outcomes will be compared across two conditions: a control condition – simulation training courses, delivered 3 months prior to the introduction of the e-learning intervention (n = 200 participants) and an intervention condition – simulation courses delivered in the 3 months following introduction of the compulsory e-learning intervention (n = 200 participants). Analysis Mixed models analyses will compare control and intervention conditions on: (1) participants self-reported ratings of pre-training anxiety (2) time spent debriefing, annotated from video and (3) participants’ improvement in health care skills, assessed through questionnaire assessments pre and post training. The results of this evaluation will be presented. Reference Reedy, Simpson, Anderson, Lavelle. Development of the Human Factors Skills for Healthcare Instrument: A Valid and Reliable Tool for Assessing Interprofessional Learning Across Healthcare Practice Settings. BMJ Simulation and Technology Enhanced Learning. Under Review.

Safer catheter care is a focus for quality improvement in healthcare. Catheter associated urinary tract infections are a major cause of bacteraemia and are often avoidable. The Safer Catheter Care course was designed to increase knowledge of catheter care and support a pan-London catheter care improvement programme in collaboration with the Health Innovation Network South London. Methodology A half-day simulation course consisting of a catheter knowledge workshop and two clinical scenarios, adaptable to hospital or community settings. The scenarios are followed by a structured debrief. Objectives are to improve knowledge of safer catheter care, raise awareness of the catheter passport document, and to relate practice to non-technical skills. Results A significant increase in self-reported knowledge and confidence in catheter care (p 0.03, 0.05 respectively) was found. Self-efficacy also increased, however not significantly. Qualitative information reported by learners suggest learning themes around non-technical skills and catheter care. Follow-up questionnaires to participants are currently being circulated to examine sustained learning. Potential impact The course was designed to support a quality improvement and patient safety initiative and has led to significant increases in self-reported knowledge and confidence. Evaluation comments identified a misconception amongst learners that the course would cover catheter insertion, and showed a varied level of experience in caring for catheters. The advert was redesigned making the course aims explicit, with the course structure changed to include a catheter care workshop. These factors may have contributed to changes in self-efficacy being non-significant. The course design, covering a half-day session, may also have an impact. This short format could present learners with an opportunity to explore their limitations without providing the time to practice and apply identified non-technical skills. A possible future design for the course is therefore in extending the format and increasing learning opportunities within simulated scenarios and debriefs.

Background Simulation is an expensive education modality. Significant time in training sessions is used to explain simulation, debriefing, human factors, and establish psychological safety. E-learning programs are an ideal complement to simulation training to provide information to participants prior to, and beyond, the simulation day. At present, e-learning programs that run in tandem with simulation are limited to addressing technical knowledge, and there are no e-learning resources available for simulation faculty development. Description of innovation Through a collaborative project, involving four simulation centres (King’s Health Partners) in South London, we have developed a comprehensive simulation e-learning program that goes beyond technical skills providing educational development opportunities for simulation participants and faculty. It is applicable across a range of healthcare simulation settings from community mental health, acute intensive care to undergraduate training. The program consists of three zones, which are being rolled out consecutively from June 2016. ‘Preparation for Simulation’; compulsory pre-learning for participants attending any simulation training. This introduces the concepts of simulation, the simulated environment, and debriefing. This will reduce the time needed in course introductions and reduce participant anxiety prior to training, helping to improve efficiency and psychological safety, optimising the learning potential. ‘Further Learning’; modules on Human Factor skills in healthcare, debriefing and reflective practice, to improve the retention of skills learned in training. ‘Faculty Development’; modules for faculty including topics such as advanced debriefing, and how to facilitate Human Factor skills teaching. The impact of zone 1 on training efficiency and participants’ psychological safety and learning is currently being evaluated. Conclusion This is the first ever e-learning program for participants attending simulation courses, designed to enhance psychological safety, improve efficiency of simulation courses, knowledge about human factors and debriefing, and to provide learning resources for simulation faculty. *

Introduction Cardiac disease in pregnancy remains the leading cause of mortality and morbidly worldwide. Recognition and management can be challenging. In response, we developed a multi-disciplinary simulation-based training programme; 50% practical/technical skills and 50% human-factors/non-technical skills (communication, leadership and teamwork). Objectives Utilising a systematic ABCDE approach, knowing & understanding the symptoms, signs & management of cardiac disease in pregnancy and be aware of the important human factors to improve patient safety. Methods Each scenario involved a simulated-patient, played by the Maternal Simulator (Noelle®), an embedded practitioner and course participants (3–5) comprising of midwives, obstetricians, physicians and anaesthetists. Scenarios included acute coronary syndrome, pulmonary oedema, aortic dissection and cardiac arrest. Results This study evaluated the educational impact of six one-day courses with healthcare staff (n = 84). There was an improvement in both participants’ knowledge, clinical management of cardiac disease in pregnancy and an improvement in a validated and reliable self-efficacy human-factors toolkit; I am confident in my knowledge of the physiological changes of the heart in pregnancy. The chi-square statistic was 15.4189. The p-value was I am confident in managing pregnant women with cardiac disease. The chi-square statistic was 15.4756. The p-value was Using the Human Factor Skills for Healthcare Instrument 0–10 score. The paired two-tailed T-test of 42 sets of paired pre and post data had a mean change 0.96. The value of t was 6.854051. The p-value was Discussion This course provided technical knowledge and confidence in managing cardiac disease, whilst allowing for a greater understanding of others’ professional roles. Simulation-based education is a promising avenue for reducing the mortality and morbidity of cardiac disease in pregnancy. It is responsive to the changing needs of the team whilst managing a pregnant woman.

Background One of today’s healthcare challenges is to ensure that those caring for residents must value and respect the individual, whilst working within the large machines of the health and social care system to ensure seamlessness. Other targets include avoiding hospital admissions, early referral, reduced rates of pressure ulcers and falls. Aims To identify common reasons for hospital admission from a set of care homes in South London. To design an inter professional education programme to address some of the care, compassion and technical issues that may have contributed to previous hospital admissions. Method Healthcare disciplines attached to the care homes including GPs, district nursing and allied health staff and care staff from two residential homes attended a 1.5 day simulation programme that included skills stations, physical limitation suits and actor based simulation. Results Candidates found it difficult to recognise they were on the same playing field as all other learners who attended. The low fidelity activities appear to have had a higher impact than the high fidelity scenarios. Staff have reported greater confidence in communicating across professionals and disciplines. It was difficult to release staff in the time scale that the funding was provided to deliver this project within, so total IPE was not achieved on each course. Conclusion Providing an inter-professional course across four health and care provider organisations is challenging, but can be successful if you persevere and have appropriate funding. Debriefing and analysing delegate feedback has allowed us to identify common issues for staff across these disciplines that can affect hospital admission and improve communication across the varied levels of staff and organisations. This review has allowed us to refine the course and secure funding to extend this to a further 12 more courses over the next two years. Reference Francis (2013) The report of the Public Inquiry into the Mid Staffordshire NHS Foundation Trust

This article considers the link between emotional resilience and the mental and physical wellbeing of healthcare staff, and how this affects leadership and patient care. The authors outline six steps to building and sustaining emotional resilience. In two NHS surveys (Boorman 2009, Healthcare Commission 2010) staff reported that their physical health and emotional wellbeing affected their ability to undertake daily activities and their ability to care for patients. Some NHS trusts are addressing staff wellbeing through emotional resilience training. Guy's and St Thomas' NHS Foundation Trust, London, for example, includes it in its preceptorship programme, which supports transition from student to staff nurse.