1. The use of distance learning technologies to bring simulation- based critical care training to a remote community in northern Canada Timothy Willett, RCPSC; Susan Brien, RCPSC; Pierre Cardinal, RCPSC & uOttawa; Rick Hodder, uOttawa; John Kim, uOttawa; Dave Neilipovitz, uOttawa; Shahin Shirzad, UBC. 2011 MedBiq Conference, 11 May 2011

2. Critical care Patients with an imminently life-threatening condition Time is tissue Community: Critical illness can happen anywhere Community practitioners  recognition & early intervention Training: Simulation-based ABCs, crisis resource management 2

3. 3 Vancouver Toronto Montreal Ottawa Iqaluit

4. Iqaluit (formerly Frobisher Bay) ~3000 km from tertiary care Population 6,200 Only hospital in Nunavut (population 30,000) Nunavut > 2,100,000 sq km  15 th in world! 4

5. Challenges Health human resources Transport Access to CPD Cost (either way) Goal: Test a distance-learning model of a simulation-based critical care course (ACES) 5

6. Methods Funding: Health Canada RBC Foundation Royal College 1)Needs assessment Context Priority needs Learners 2)Modify course 6

7. Methods 3)Delivery Web modules Lectures Case discussions Task training Simulation 4)Evaluation Questionnaires Pre- and post-course quiz Post-course simulation (on-site) Delayed interviews 7 TeleMedicine

8. SimuCase Virtual Patient 8 Learners Operator Facilitator

9. Results: Sessions 4 web modules poorly used access issues well-liked TeleMedicine: 8 sessions 4 hrs lecture & cases 3.5 hrs task training 4 hrs SimuCase VP 9 “In terms of the [TeleMedicine], the mannequins, that kind of thing and doing this all kind of on a long distance basis, I think it was effective.”

10. Results: Questionnaire 10 Relevant Videoconference effective Technical skills improved Confidence increased Will not change practice SimuCase allowed practice SimuCase feedback useful

11. Results: Quiz 28% improvement Paired t-test (n=10): p=.016 Cronbach’s alpha: 0.67 11 GroupnMean score (/20) Iqaluit (pre)159.5 Iqaluit (post)1012.5 Junior ICU residents57.7 Senior ICU residents613.6

12. Results: High-fidelity simulations 2 cases 10 physician candidates: 1 leader, 1 assistant RN actor 2 facilitators from Ottawa Videotaped Checklist: Custom, Delphi process GRS: “Ottawa GRS” Standard: Modified Angoff 12

13. Results: High-fidelity simulations 13 MeasureCase 1 (GI bleed)Case 2 (Sepsis) Expected score Mean candidate score % met or exceeded expected Expected score Mean candidate score % met or exceeded expected Checklist score19.024.69020.126.7100 Ottawa GRS: Overall performance score 4.25.3704.25.7100 Leadership skills4.55.6604.56.190 Problem-solving skills3.85.4903.85.6100 Situational awareness skills 4.35.1704.05.6100 Resource utilization skills4.05.61004.05.9100 Communication skills4.86.1904.86.290

14. Results: Delayed interview (prevalent themes) Positive experience, appreciative Well qualified instructors Technical problems not significant Changes in: Approach to critically ill patient / priorities Vasoactive medications Assessment / monitoring Confidence Communication Delivery strategy was effective; liked the on-site simulations SimuCase was effective; enhanced skills applicable to high-fidelity simulation 14

15. Lessons learned Support from decision-makers Community-based coordinator TeleMedicine tech support Web modules: disc backups Virtual patient works Outcomes positive Limitations: Pilot study, small n, limited rigour 15

16. Thank you Questions? twillett@royalcollege.ca 16