Specialty
Paediatric intensive care

Educational technique
High fidelity mobile paediatric simulation training

Imperial College Healthcare paediatric simulation training
At Imperial College Healthcare’s St. Mary’s Hospital, the paediatric and infant simulation group has trained over 200 junior doctors and 100 nurses in 300 sessions since 2005, utilising a mobile high fidelity infant simulator and incorporating at least two simulated sessions per trainee.

The main faculty group consists of two paediatric intensive care consultants (Dr Claudine de Munter who leading the group and Dr Mehrengise Cooper), a paediatric anaesthetist (Dr Sanjay Gautama), and a paediatric intensive care nurse (Anne Dowson).

Passionate about helping doctors, nurses and allied health professionals to increase their paediatric knowledge, training is ongoing and includes weekly simulation-based scenarios and twice-monthly in situ simulation training exercises.

Weekly simulation-based training sessions are scheduled and use a highly realistic, computerised baby mannequin to focus on the skills and knowledge required for the resuscitation of acutely ill infants. These simulations take place on paediatric wards with training-grade paediatricians and nursing staff and with the assistance of two senior paediatric intensive care nurses.

Twice-monthly in situ simulation-based training involves using the same equipment to facilitate sudden and unexpected training sessions which can take place anywhere children may be within the hospital. Doctors and nurses involved in these sessions receive an urgent call to attend the location of the simulation and are usually unaware that the scenario is a training exercise until they arrive on the site. In line with the realistic nature and multidisciplinary approach of this situational training method, the simulation includes anaesthetists, resuscitation officers and paediatric intensive care medical and nursing staff. Simulations are also carried out on the general paediatric wards and can consequently involve the ward staff and its equipment, thus facilitating a multidisciplinary and highly realistic form of training. These sessions are followed by audio and video based feedback.

Simulation-based training also takes place at a newly installed paediatric research unit (PRU) which has a dedicated general paediatric ward and digital recording equipment. Scenario performance and post-simulation debriefing can then be managed from an adjoining control centre, allowing for detailed audio and video based feedback.

The purpose of simulation scenarios is to train paediatric medical and nursing staff in paediatric resuscitation. The training is multidisciplinary, meaning that various healthcare professionals are required to work together to achieve a common goal. The training encompasses technical (clinical) and non-technical skills such as human factors (including rapid decision-making, leadership and communication skills). Relevant scales of assessment have also been developed with input from psychologists of the department of surgery and these are also used.

Following each session, trainees receive debriefing and feedback. Senior nurses debrief participating nurse trainees, and consultant paediatric intensivists and paediatric anaesthetists debrief the medical trainees. Since early 2008, mobile video recordings of the simulated crises have been used as key part of this debriefing process. Upon completion of the debriefing, all comments on technical and non-technical performance of the trainee are manually recorded on a debriefing sheet, which the trainee takes with him/her as a means to reflect further on their performance.

Imperial college Healthcare’s paediatric and infant simulation group has been systematically evaluating this form of training since its inception. All participating trainees complete evaluation forms at the end of every simulation exercise and evidence shows that all trainees find the experience relevant, realistic and highly beneficial.

The paediatric and infant simulation group also carries out studies to assess the efficacy of simulation-based training and to provide evidence for integration of such training into the standard training curricula in paediatrics.

In addition, a clinical skills laboratory has recently opened in the department of paediatrics, where paediatric trainees, nurses, physiotherapists and all members of the multidisciplinary team are able to train on various practical techniques used in paediatrics such as airway control, intravenous access, lumbar punctures and chest drain insertions.

For more information on this approach to paediatric training or to participate, contact Dr Claudine De Munter or Dr Mehrengise Cooper.

London Deanery School of Paediatrics simulation training
In addition to Imperial College Healthcare’s own paediatric simulation training programme, consultant paediatric intensivist, Dr Mehrengise Cooper is also the London School of Paediatrics lead for simulation and together with a group of collaborative centres, this group has developed a programme for all paediatric ST3 trainees in London.

The goals of this standalone group are to enable all paediatric trainees in London to be exposed to challenging paediatric intensive care situations in a safe environment. This will lead to a reduction in adverse events for patients and expose latent errors, which will lead to an improvement in patient safety.

This programme has been supported by the London Deanery’s simulation and technology-enhanced learning initiative (STeLI) and has received extremely positive feedback. These ST3 courses have been run at Imperial College Healthcare’s St. Mary’s Hospital, both as full immersion simulation and part-task/communication training.  

Feedback from the ST3 programme at Imperial was once again very positive and the programme will continue to run throughout 2011 with STeLI support.

The faculty for these courses for Imperial College Healthcare are: Claudine de Munter, Rebecca Salter, Jenny Ziprin, Lidia Tyszczuk, Mando Watson, Bob Klaber and Mehrengise Cooper. To attend a London Deanery School of Paediatrics simulation training course, contact Dr. Mehrengise Cooper directly.