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Implementing a Nationwide Simulation-Based Training Program in Managing Sick Surgical Patients

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Abstract

For residents or fellows outside anesthesiology and critical care training programs, formal training in managing critically sick patients does not exist in India either at the undergraduate level, or at postgraduate level. Acute critical care course (ACCC) is a simulation-based skills development course that has been developed indigenously to address this lacuna in training of interns and residents in surgical specialties and emergency medicine in India. This study is aimed to find out and to assess the effectiveness of this course.

This is a prospective interventional study using low-fidelity simulation-based courses. As many as 1036 candidates (interns and residents) were trained in 40 ACCC provider courses, and 165 instructor candidates in 9 instructor courses in 16 teaching hospitals in India in 2014–2021. However, in this report, the authors have analyzed the feedback (verbal and written) from 487 candidates of 19 ACCC provider courses conducted in 14 teaching hospitals in India between 2014 and 2018. Analysis of data was performed by thematic analysis for qualitative data and descriptive analysis for quantitative data.

All the 487 candidates in 19 courses over 5 years replied either as very good (above expectations) or as good (as per expectations). In response to the question of the effectiveness of a lecture or skill station, none of them chose the options fair (below expectations) or poor (unacceptable). Fifteen out of 18 interns replied their emails that were sent 3 weeks after ACCC to find out if there was an improvement in their clinical application on a scale of 1–10. The response to the question in regards to improvement in their own ability ‘to assess a sick patient’, ‘in treating a sick patient’, ‘communication skills with a colleague’, and ‘confidence in breaking bad news to patient or relatives’, respectively, was 7.5, 7.8, 8.3 and 8.3. Mean scores out of 5 in response to content of ACCC course for clarity, utility, adequacy of content, understandable and interaction during course were 4.59, 4.81, 4,78, 4.86 and 4.97 respectively. Qualitative analysis led to 5 themes described in the manuscript.

Low fidelity simulation using role-play appeals to the adult learners, breaks the monotony of classroom teaching, encourages interactive learning, and facilitates active participation in skill development necessary for critical care training of residents in surgical specialties and in emergency medicine. Sharing the vision document of ACCC with the deans of medical colleges is the crucial step in implementing applied physiology in step-wise logical approach in managing a sick patient.

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References

  1. Prayag S (2002) ICUs worldwide: critical care in India. Crit Care 6(6):479–480

    Article  PubMed  PubMed Central  Google Scholar 

  2. Naeem N, Montenegro H (2005) Beyond the intensive care unit: a review of interventions aimed at anticipating and preventing in-hospital cardiopulmonary arrest. Resuscitation 67(1):13–23

    Article  PubMed  Google Scholar 

  3. Mishra MC. 2013 ATLS Subcommittee; International ATLS working group. Advanced trauma life support (ATLS®): the ninth edition. J Trauma Acute Care Surg. 74(5) 1363–6

  4. White RJ and Garrioch MA(2002) Time to train all doctors to look after seriously ill patients - CCrISP and IMPACT. Scot Med J 47:127

  5. Goldacre MJ, Lambert T, Evans J, Turner G (2003) Preregistration house officers’ views on whether their experience at medical school prepared them well for their jobs: national questionnaire survey. BMJ 326:1011–1012

    Article  PubMed  PubMed Central  Google Scholar 

  6. Smith GB, Poplett N (2004) Impact of attending a 1-day multi-professional course (ALERTTM) on the knowledge of acute care in trainee doctors. Resuscitation 61:117–122

    Article  PubMed  Google Scholar 

  7. Jones D, George C, Hart GK, Bellomo R, Martin J (2008) Introduction of medical emergency teams in Australia and New Zealand: a multi-centre study. Crit Care 12:R46

    Article  PubMed  PubMed Central  Google Scholar 

  8. Peter JV, Thomas K, Jeyaseelan L, Yadav B (2016) Cost of intensive care in India. Int J Technol Assess Health Care 32(4):241–245

    Article  PubMed  Google Scholar 

  9. Divatia JV, Amin PR, Ramakrishnan N (2016) Intensive care in India: the Indian intensive care case mix and practice patterns study. Indian J Crit Care Med 20(4):216–225

    Article  PubMed  PubMed Central  Google Scholar 

  10. Tissingh E, Hayley Allan H, Vig S (2014) Courses for surgical trainees. BMJ 348:g3323

    Article  Google Scholar 

  11. Sokhal N, Kumar A (2021) Aggrawal R et al Acute critical care course for interns to develop competence. Natl Med J India 34:167–170

    Article  PubMed  Google Scholar 

  12. Kumar A, Sokhal N, Aggrawal R et al (2021) Communication skills training through ‘role play’ in an acute critical care course. Natl Med J India 34:92–94

    Article  PubMed  Google Scholar 

  13. Kumar A, Aggarwal R, Sharma AK (2021) Acute critical care course for clinicians- why, what and how? Indian J of Surg 83:1–2

    Google Scholar 

  14. sitecore\TDoncaster@rcseng.ac.uk. Home [Internet]. JCST. [cited 2022 May 6]. Available from: https://www.jcst.org/

  15. Home [Internet]. [cited 2022 May 6]. Available from: https://www.gmc-uk.org/

  16. sitecore\MGujadze@rcseng.ac.uk. Courses [Internet]. Royal College of Surgeons. [cited 2022 May 6]. Available from: https://www.rcseng.ac.uk/education-and-exams/courses/

  17. Becoming Certified | American Board of Surgery [Internet]. [cited 2022 May 6]. Available from: https://www.absurgery.org/default.jsp?examoffered

  18. Pietrasik T. “Two Indias exist everywhere, especially in healthcare” – video. the Guardian [Internet]. 2013 Jan 7 [cited 2022 May 6]; Available from: http://www.theguardian.com/global-development/video/2013/jan/07/india-healthcare-video

  19. Ali J, Kumar S, Gautam S, Sorvari A, Misra MC (2015) Improving trauma care in India: the potential role of the Rural Trauma Team Development Course (RTTDC). Indian J Surg 77(Suppl2):227–231

    Article  PubMed  Google Scholar 

  20. Sharma A, Halawa A, Bridson JM, Prescott D, Guha A, Strivens J, Taylor DC (2017) Implementation of critical threshold concept in clinical transplantation: a new horizon in distance learning. World Journal of Educational Research ; 4(2): ISSN 2375–9771 (Print) ISSN 2333–5998 (Online)

  21. Joined-up listening: integrated care and patient insight [Internet]. The King’s Fund. 2018 [cited 2022 May 6]. Available from: https://www.kingsfund.org.uk/publications/joined-up-listening-integrated-care-and-patient-insight

  22. McKimm J (2009) Giving effective feedback. Br J Hosp Med 70(3):158–161

    Article  Google Scholar 

  23. Pendleton D, Schofield T, Tate P, Havelock P (1984) The consultation: an approach to learning and teaching. Oxford University Press, Oxford

    Google Scholar 

  24. Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77–101

    Article  Google Scholar 

  25. Thatte UM, Marathe PA (2017) Ethics committees in India: past, present and future. Perspect Clin Res 8(1):22–30

    Article  PubMed  PubMed Central  Google Scholar 

  26. Nicol D (2008) Transforming assessment and feedback: enhancing integration and empowerment in the first year. Scotland, UK: Quality Assurance Agency

  27. Morrow SL (2005) Quality and trustworthiness in qualitative research in counseling psychology. J Couns Psychol 52(2):250–260

    Article  Google Scholar 

  28. Kirkpatrick DL (1967) Evaluation of training. In: Craig R, Mittlel I (eds) Training and development handbook. McGraw-Hill, New York, pp 87–112

    Google Scholar 

  29. Dyson RG (2004) Strategic development and SWOT analysis at the University of Warwick. Eur J Oper Res 152(3):631–640

    Article  Google Scholar 

  30. Bibby J, Bevan H, Carter E, Bate P, Robert G (2009) The power of one, the power of many. Institute for Innovation and Improvement NHS Available from: http://www.nhsleadershipqualities.nhs.uk/a. Accessed 1 Mar 2022

  31. Lund O, Andersen B, Christensen MK (2016) Old habits die hard: a case study on how new ways of teaching colonoscopy affect the habitus of experienced clinicians. Int J Med Educ 7:297–308

    Article  PubMed  PubMed Central  Google Scholar 

  32. Bajwa SJS, Kaur J (2014) Critical care challenges in obstetrics: an acute need for dedicated and co-ordinated teamwork. Anesth Essays Res 8(3):267–269

    Article  PubMed  PubMed Central  Google Scholar 

  33. Bajwa SK, Bajwa SJ, Kaur J, Singh K, Kaur J (2010) Is intensive care the only answer for high risk pregnancies in developing nations? J Emerg Trauma Shock 3(4):331–336

    Article  PubMed  PubMed Central  Google Scholar 

  34. Bajwa SK, Bajwa SJ (2012) Delivering obstetrical critical care in developing nations. Int J Crit Illn Inj Sci 2(1):32–39

    Article  PubMed  PubMed Central  Google Scholar 

  35. Say L, Souza JP, Pattison RC (2009) Maternal near miss – towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynaecol 23(3):287–296

    Article  PubMed  Google Scholar 

  36. Blom L, Petersson P, Hagell P, Westergren A (2015) The situation, background, assessment and recommendation model of communication between health care professional: a clinical international pilot study. Int J Caring Sciences 8:530–535

    Google Scholar 

  37. Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP (2000) SPIKES—a six-step protocol for delivering bad news: application to the patient with cancer. Oncologist 5:302–311

    Article  PubMed  CAS  Google Scholar 

  38. Coiera EW, Jayasuriya R, Hardy J, Bannan A, Thorpe MEC (2002) Communication loads on clinical staff in the emergency department. Med J of Aus 176:415–418

    Article  Google Scholar 

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Authors and Affiliations

  1. Command Hospital Lucknow, Lucknow, India

    Vikas Chawla

  2. Critical and Intensive Care, JPN Apex Trauma Centre All India Institute of Medical Sciences, New Delhi, India

    Richa Aggarwal

  3. Department of Neuroanaesthesia, JPN Apex Trauma Centre All India Institute of Medical Sciences, New Delhi, India

    Keshav Goyal & Navdeep Sokhal

  4. Sandwell and West Midlands NHS Trust, Birmingham, UK

    Geeta Shetty

  5. Transplantation and Surgery, Royal Liverpool University Hospital, Liverpool, UK

    Ajay Kumar Sharma

  6. Core Surgical Training Merseyside, North West of England, Liverpool, UK

    Ajay Kumar Sharma

  7. Royal College of Physicians and Surgeons of Glasgow, Glasgow, UK

    Ajay Kumar Sharma

  8. Royal Army Medical Corps, British Army, UK

    Ajay Kumar Sharma

  9. Maulana Azad Medical College, New Delhi, India

    Pawanindra Lal

  10. Lister Hospital, Stevenage, UK

    Selva Kumar

  11. JPN Apex Trauma Centre All India Institute of Medical Sciences, New Delhi, India

    Mahesh Misra

  12. Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India

    Akshay Kumar

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  1. Vikas Chawla
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  4. Navdeep Sokhal
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  7. Pawanindra Lal
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  8. Selva Kumar
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  9. Mahesh Misra
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Chawla, V., Aggarwal, R., Goyal, K. et al. Implementing a Nationwide Simulation-Based Training Program in Managing Sick Surgical Patients. Indian J Surg 85, 1374–1383 (2023). https://doi.org/10.1007/s12262-023-03740-0

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