Simulation-based learning for acute stroke medicine

Introduction: In 2012, an innovative programme of simulation-based training produced a unified approach to training acute stroke teams across several London hospitals. Based on the London Model (http://www.slcsn.nhs.uk/lss/lit.html), this is the first time a standardized protocol-based curriculum has been rolled out across multiple hospitals in a geographic area of the UK. Objectives: This project reports on comprehensive evaluation data collected at various points during the programme, designed to answer the question of whether there has been a significant demonstrable shift in learning and in behaviour in practice. In addition to specific scenario-based learning outcomes, the learning outcomes included time management and decision-making, working with colleagues, and recognition and management of acute deterioration in a stroke patient. Material/Patients and Methods or Expected Audience: The project used a mixed-methods evaluation approach. Data were collected from participants before, during, and at multiple time intervals after the interventions. The unique design of the training programme also allowed examination of differences between different simulation centres’ implementation of the programme, between different hospitals’ practices and implementations of the London Stroke model, between staff with different roles and levels of experience, different time to follow-up and between specific programme components. Pre- and post-intervention surveys (n=165) measured changes in participant self-efficacy, a psychological construct related to domain performance, regarding learning outcomes. Open-ended, topical interviews (n=20) at time intervals after the intervention explored how the learning objectives were met, what information was retained, and what implications this has had for personal development, for practice, and for patient care. Results / Requirements/Specific needs: Data analysis, which is still in process, consists of comparison of pre and post course survey data via analysis of variance, and a thematic analysis of qualitative data. Initial analysis of quantitative data show an increase in perceived self-efficacy among candidates in the domains associated with the intended learning outcomes, and also in the specific area of using a standardized early warning reporting system. However, this increase was lower among more advanced clinicans (those with extensive experience working in a high-acuity stroke unit). Initial analysis of qualitative data show that nurses find the training more specifically relevant to subsequent clinical situations than do doctors, who report that the simulation is generally worthwhile but not necessarily immediately relevant. Both doctors and nurses are less able to specifically recall and associate the learning activities with clinical practice over time. Conclusion / Description of the session: Data from this project show that the training programme is effective in helping achieve the associated learning outcomes. This project demonstrates that carefully designed simulation programmes, which are congruent with clinical practice, can provide valuable training opportunities that support patient care.