Getting to grips with trauma by remote simulation
Training medical and nursing students using high-fidelity manikins is nothing new, but an innovative NSW program is now offering emergency departments procedural training using lifelike simulators operated remotely.
Under the Emergency Department Hub and Spoke Distributed Simulation using the Education by Web-based Innovative Simulation and E learning model (EdWISE) project, hospitals in NSW are being offered the opportunity to train medical and nursing students and new graduates in trauma, cardiac, airways and paediatric emergencies in the hospital itself.
Training simulators are freighted to the hospital, where local trainers provide hands-on skills development and the simulators are operated remotely from the Sydney Clinical Skills and Simulation Centre (SCSSC) at Royal North Shore Hospital.
Technical staff at the SCSSC operate the simulators over the Internet using remote desktop software, while teachers at the centre can also provide instruction via video conferencing. Sessions are available to any NSW public hospital or university that is interested.
SCSSC director, Clinical Associate Professor Leonie Watterson, said simulation training has been slow to develop in many hospitals for a variety of reasons, with access to teachers and equipment the two major constraints. By sending the equipment to the hospital and operating it remotely, the project aims to overcome these barriers, Dr Watterson said.
“This approach has only been described once as a proof of concept so it’s a great achievement for an Australian group to be delivering a large-scale program using this method,” she said.
The project is led by the SCSSC in partnership with the Clinical Education and Training Institute (CETI), which coordinates the education and training for NSW Health staff, the University of Sydney and Royal Prince Alfred Hospital. It is funded by Health Workforce Australia as part of a program aimed to increase training capacity for health professional students, especially in the rural sector.
Dr Watterson said the centre will send equipment packs to the hospital that include a variety of robotic simulators and any of the ancillary equipment needed such as portable ventilators and defibrillators. The local team then assembles the equipment and local teachers come in to provide some of the training. They communicate with the centre by video conferencing.
“We use remote desktop protocols, and that's over broadband, to control the robots,” Dr Watterson said. “When it comes to the interaction between the teachers and the students, we looked at a few IT options.
“One is to do it over the web using something like Skype. People have reported doing that, including a Japanese group that has done a pilot and one in the US that did a very small pilot as well. They both used Skype but we looked into it and we didn't feel we'd get good enough quality, so we are using standard video conferencing on the NSW system.
“We use video conferencing codecs and we also felt it was important to get it working not just on the NSW Health network but also on the university AARNet network. We've got it working on that so if people want to set up the training in their university clinical schools rather than in the emergency department, they can do that as well.”
There are a range of simulators used, including baby, adult and mother models like SimMan, SimBaby and SimMom. The focus of this particular project is on training in emergency departments, with four themed modules including trauma, cardiac, paediatrics and airways, although the centre is planning to introduce another module using Sophie and her Mum, a full birth obstetric model.
A surgical module is also in the planning using the bench-top models predominantly used in surgical simulation training.
"That technology is focused on haptic-based virtual reality and screen-based simulation,” Dr Watterson said. “The manikin simulators haven't got a great deal of functionality [for surgery training], although we have been doing some work on improving that for surgical emergencies. There are quite a few bench-top models that are very relevant, particularly for students and more junior staff for suturing and plastering and things like that.”
The project also includes an E Learning site, a repository of learning materials designed to complement the on-site simulation program or be used for independent learning.
Topics target all levels of experience, from students and new graduates to more experienced postgraduate emergency nurses, residents and junior registrars. Topics include how to take a 12 lead ECG, how to defibrillate and how to perform transcutaneous pacing, cervical immobilisation, pelvic splinting or the log roll.
The EdWise training project is fully funded until June 30, 2013 – with hopes that funding will be extended – so hospitals can participate for free until then. Dr Watterson said that so far, 13 hospitals have taken part involving 500 student hours.
The SCSSC is currently developing the capacity to do recording and local playback so students can review their session. Interested hospitals can contact the centre to discuss their needs, particularly those in rural areas that might have different needs to metropolitan tertiary hospitals, Dr Watterson said.
Posted in Australian eHealth