The Otago Clinical Skills Laboratories
Simulation-Based Education is a key component of ongoing clinical education for all healthcare workers and upcoming healthcare professional students. While clinical emergencies cannot be predicted, they can be rehearsed to enable health professionals to practice clinical procedures, effective communication, and test processes.
The Otago Clinical Skills Laboratories (OCSL) is a joint venture established in 2008 between Te Whatu Ora Southern and the Dunedin School of Medicine, catering to all Te Whatu Ora Southern clinical staff, and medical and nursing students in their 4th to 6th clinical years of study. Although a fairly small facility, the footfall coming through the OCSL is ever increasing. Hundreds of health professionals and students attend courses and tutorials annually to learn and maintain clinical skills important for providing effective, timely, and caring medical management.
The OCSL strives to be a repository of simulation-based education expertise, high-fidelity simulation equipment, and a fit-for-purpose facility to allow for state-of-the-art simulation education and training. To this end, the OCSL has recently completed a major refurbishment of its facility and employed an interprofessional team of simulation educators that has allowed it to pivot further towards simulation program design and delivery. This mahi aligns with the Interprofessional Learning Centre (ILC) building project, planned alongside the new Dunedin Hospital, and will be a strategic investment in our district's healthcare workforce development.
The Simulations
Simulation comes in many forms, and this is always guided by the desired learning outcomes that need to be achieved. Patient consultation skills scenarios are run in the facility’s consult rooms that resemble a GP clinic or an outpatient department. These scenarios help participants understand and familiarize themselves with a patient’s day visit procedures, from reception to the end of the visit. Practical skills, from cannula insertion to airway intubation, are practiced with skill trainers in the procedural labs. High-fidelity simulation manikins are used in the hospital bed bay, with its adjoining control room, for complex clinical emergencies or when an inter-professional team approach is needed.
The common feature of all simulation education sessions is a facilitated debrief, by which participants can reflect on their practice and consider what they will take from their simulated experience to clinical practice. Examples of simulation training programs run by the OCSL are expanded upon below. Their focus is on interprofessional training and run across the hospital in various medical and surgical areas involving Nursing, Medical, Allied Health, Scientific, and Technical staff, and Orderly service.
- The ‘New to Practice’ Simulation Programme provides an interprofessional training opportunity for new graduates throughout Southern twice a week. The simulation-based education targets Nursing Entrants to Practice (NETP) Nurses, Post Graduate Year One and Two Medical House Officers, and new graduate Allied Health, Scientific and Technical staff. These training opportunities can cover:
- Making a ‘mock 777’ clinical emergency call
- Primary assessment of Airway, Breathing, and Circulation (ABC)
- The administration of emergency medications including adrenaline or midazolam
- The administration of the emergency trolley contents.
Seizure and status epilepticus management, as well as advanced cardiac life support, are two of the most well-received topics among participants.
- The ‘In-Situ’ Simulation Programme is set in the participants’ usual work environment. The OCSL team work collaboratively with the Nurse Educators, CNM/ACNMs and Medical Leaders across all departments in at least 18 different areas of Dunedin and Wakari Hospital. The advantage of this is that participants practice scenarios within their own clinical environment and with their native teams. This is about team building and maintaining operational readiness to manage common emergencies such as cardiac arrest, anaphylaxis, seizure, respiratory compromise, metabolic emergency, and patient fall. At times bespoke scenarios to specific areas are also implemented, such as ED: anaesthetic toxicity, sepsis, and paediatric emergency specific conditions.
- NetworkZ is a national simulation programme based in Auckland that focuses on improving communication and teamwork in emergency departments and operating theatres. The OCSL supported the regional rollout of this programme by purchasing an additional high-end manikin, which secured access to both Southland and Otago. The OCSL continues to support the programme on the Dunedin campus by providing technical expertise in running and maintaining the high-end simulation equipment.
Amy Suddaby, Nurse Educator for Southern Blood and Cancer, recommends the In-Situ Simulation Programme because it helps iron out issues or anticipate potential issues before they happen in real practice. "It allows everyone to feel supported to practice new skills, understand processes and procedures - including role allocation in an emergency, as well as leadership and communication skills. It is an opportunity to discuss what went well and what improvements can be made."
David Williams, Pain Clinic Clinical Coordinator and Physiotherapist, says that a simulation training session gives staff an opportunity to practice their response to emergencies. He recalls that a week after their most recent simulation, his team had a patient experience - a medical event similar to what was covered in the simulation - so the response to the real-life event was smooth, calm, and ran like clockwork.
All the NETP nurses are encouraged to attend the simulations, especially the 60-minute New to Practice programme. Colette Parai, New Entry to Practice (NETP) and Enrolled Nurse Support in Practice Programme (ENSIPP) Coordinator, says she has seen how the New to Practice simulation programme helps to develop the participants’ confidence in their practice. Colette also shared that "there is evidence that attending simulations helps new nurses through a period called ‘Transition Shock’, which comes as they are required to take on more responsibility and critical thinking and they start mentally transitioning from student to nurse.”
In addition to the above programmes, the OCSL also runs one-off simulations on demand to help test new spaces or policies. Covid posed particular challenges on how health care is delivered. Simulations, including the COVID-19 Rural Trauma Rescue, Patient Transport Simulations, and scenarios played out in the Covid ward, helped inform the hospitals’ response and planning.
More recent 2022 simulations include the Dunedin Hospital ICU Fire Evacuation, New Rheumatology, Pain Service and Physiotherapy Outpatients Commissioning Simulation, and Dunedin Immunisation Centre Paediatric Anaphylaxis sim. In mid-March, the OCSL is carrying out a commissioning simulation with Hato Hone St John for the new Ophthalmology Surgical Centre opening on Filleul St, to orientate the staff to the emergency management process in the new facility.
Dr Ohad Dar, OCSL Clinical Director and ED Consultant, says that “by simulating both common and rare clinical emergencies regularly, staff maintain operational readiness. Scenarios can be designed to either test or familiarise staff to clinical guidelines, equipment, procedures, and environment. Others focus on escalation and advocacy communication skills. If the simulation is based on an adverse event, then running it maintains institutional memory.
“Generally, the role of simulation is to enhance clinical team function by assuming clear roles, utilising effective communication to achieve a shared mental model and practicing scenarios by which teams needs to be dynamic in their response.“
OCSL Facility Upgrade
The simulation suite build at the OCSL was completed in August last year. The suite simulates the real ward environment and can be customised to suit the needs of different teams. Visitors to the new build are first drawn in by the high-tech manikin SimMan3G for advanced training in emergency care procedures and the control room that allows the facilitators to lead and observe the simulation via a one-way mirror window.
Lots of simulations happen in this room, including the “Trainee Intern Simulation Week”, a part of the Dunedin School of Medicines Trainee Intern Critical Care Week. The simulation weeks are run with eight different groups over eight weeks of the year.
Imogen Christie, the OCSL Simulation Assistant and Administrator says this space is used for simulations where staff come out of their usual working environment and go to the OCSL for teaching. “For example, we have recently run a cardiac arrest sim for the resource nurses in our new simulation suite. The resources nurses work where they are most needed, meaning they move around the hospital so much that they often miss opportunities to participate in our regularly scheduled simulations. The simulation suite gives us a quiet, controlled, bookable space that looks exactly like a typical bed space you’d find in the hospital. Using the suite, the resources nurses are given an opportunity invest in their learning.”
Shaping future healthcare simulation
The OCSL instigated the formation of the Otago Simulation Interest Group (OSIG), a community of practice composed of a diverse group of health educators interested in simulation-based education. OSIG members meet monthly to talk about all things simulation and often invite guest speakers to present from around New Zealand.
“Our goal is to lead, guide, and advance simulation-based education, training, and scholarship, and provide a link between various simulation practitioners and departments within Te Whatu Ora Southern, University of Otago, Te Pūkenga Otago Polytechnic, and other institutions and services within Otago, for example, Hato Hone St John,” Dr. Dar says.
This networking puts Southern in good stead for the next phase in healthcare simulation.
The Interprofessional Learning Centre (ILC), a collaboration between Te Whatu Ora Southern, Te Pūkenga Otago Polytechnic, and the University of Otago, is planned as part of the new Dunedin Hospital project. The ILC will be an integrated, collaborative, and comprehensive education facility for health professionals and student bodies of the three partners. Individuals from the OCSL and OSIG are members of the ILC Simulation User Planning Team, which informs and feeds back into the ILC Executive Planning Team.
The OCSL as seen in Stuff: Saving Daniel: The breathing and bleeding manikin helping train NZ's medical staff
