Scotland’s Mobile Simulation Unit – our experience on Arran

In January 2017 the team at Arran Medical Group and Arran War Memorial Hospital hosted a visit from the NHS Education for Scotland Mobile Skills Unit (MSU) – or ‘Skills Bus’ as some folk refer to it. In case you haven’t seen it: the MSU is a lorry, which expands into a workshop area where patient simulation scenarios can be run from a separate control room (also on the lorry). This setup enables a modern simulation facility to be delivered anywhere in Scotland – particularly rural areas – as it only requires a flat piece of land and an electricity hook-up similar to most caravans.

The skills unit just needs a flat area of ground, and an electricity hook-up. We were grateful to Scottish Fire & Rescue for hosting the unit at Lamlash Community Fire Station.

The folks at the Managed Educational Network (MEN) at NHS Education for Scotland (NES) [don’t worry, the acronyms will stop soon!] are keen for awareness to be raised about the unit, particularly its benefits to rural teams. We hope this description of our experience will encourage others to consider arranging a visit with the associated teaching that can often be organised to coincide.

Tell me more about the unit…

The MSU operates from its base in Tayside, and can be booked by contacting the MEN team. At the time of writing, Lynn Hardie is overseeing the unit’s bookings and couldn’t have been more helpful in organising for its delivery to Arran for a week.

Once the unit is set up and expanded by the driver, who usually returns the same day back to their base following delivery, there is a large teaching area which comfortably seats up to 12 people. The unit has heating and lighting, and offers a comfortable teaching space.

The unit can be set up – using the James-Bond style concealed TV – to deliver didactic teaching presentations. Whilst this is its most basic of functions, there are some areas in Scotland which will will find this to be a useful function as part of a more comprehensive course.

However, the main purpose of the Unit is by using its SimMan, SimJunior or SimBaby, along with various provided medical paraphernalia, to enable a wide range of patient assessment simulations to be carried out. The unit has been custom-built: its layout enables pragmatic connection points for the mannequins; there is a separate control room set up with appropriate control software; and an impressive ‘SMOTS’ video system records scenarios from three different angles. This is useful both for monitoring progress through a simulation, as well as for playback during scenario feedback.

This sounds a bit complex

The kit is certainly modern, technically impressive, and requires familiarisation. However the MEN runs excellent (and free) Faculty Development Courses (FDC) – usually at the Scottish Simulation Centre in Larbert – to introduce potential hosts to the simulation equipment and also the daily setup and operation of the unit.

We found the FDC to be fun, interesting and useful – not only for the operation of the unit but for generic skills in running simulations and delivering effective feedback.

The unit also comes with relatively idiot-proof set up instructions, as well as an A-Z guide of equipment and a very helpful troubleshooting guide. This is all covered in the FDC and the MSU team also make themselves available by phone to help sort out any urgent problems during a visit.

OK, but who can we get to help us?

Dr Mark Davidson, Consultant with the ScotSTAR paediatric team, was one of several skilled colleagues who provided excellent teaching during the week.

The unit can be used by confident local teams to deliver training, however we would highly recommend requesting input from the ScotSTAR transfer teams who are often able to provide outreach support for rural training visits. In our case, over the duration of a week, we allocated Monday & Tuesday for paediatric acute care, Wednesday for obstetric emergencies, and Thursday & Friday for adult acute care. For this we were able to enlist the excellent help of the ScotSTAR Paediatric Retrieval Team, the Scottish Multiprofessional Maternity Development Programme (SMMDP) and EMRS (Emergency Medical Retrieval Service) who each came to Arran and delivered excellent teaching – including simulation sessions – during their stay.

In addition we invited a number of clinicians at Crosshouse Hospital – to whom we usually refer our cases – and their involvement was crucial both in clarifying local protocols and also understanding some of the challenges that we face in the rural and community hospital setting when referring to them and their teams.

How did it go?

Our local fire station provided excellent additional presentation space to run workshops, lectures and ample catering facilities.

We found that smaller groups worked best for simulation sessions. We also benefitted from the free use of our Lamlash Community Fire Station (who also kindly provided electricity and additional training space) as well as a daily donation of snacks and food for our Faculty from the Co-op.

Over the week the programme progressed through paediatric, obstetric and adult sessions. We allocated 10-14 clinicians into each morning or afternoon session, usually splitting them up into two groups to alternate between simulation and workshop training. We also held lunchtime ‘drop-in’ update sessions on topics such as sepsis, DKA (diabetic ketoacidosis), drug overdose and ECG interpretation; and we invited our First Responders to an evening of simulation too.

We delivered over 540 training hours during the week to Arran’s GPs, nurses, nursing assistants and paramedics/technicians, and collated feedback using SurveyMonkey – which was generally very positive and indicated an enthusiasm for doing more simulation training in the future.

What went particularly well?

Multidisciplinary colleagues worked together in simulations, and this reflected the nature of work on Arran in our community hospital.

Our teams enjoyed working in the same multi-disciplinary setup that we usually work in. For example, at our community hospital, it is common for a GP, two nurses, a nursing assistant and paramedics to continue working on an emergency case on arrival at the hospital, and we emulated this in teaching scenarios. The quality and experience of our Faculty – comprising experienced consultants, nurses and paramedics – was clearly appreciated by participants, along with the relevance of the teaching.

Prior to the training week, we surveyed our colleagues to identify what they felt were priority areas for development. As expected, sepsis and acute coronary syndrome were low down the priorities – there has already been a focus on these areas in our hospital (and nationally) over the last few years. Higher up were – obstetric emergencies, unresponsive/hypoxic children, severe asthma, drug overdose and major trauma; and so these were the areas that we focussed our training on this year.

During the week we kept a ‘Great Ideas’ board updated using post-it notes, to capture great suggestions and points for further consideration following the course. Collating this at the end of the week provided not only a snapshot of over 40 learning outcomes, but a great range of action points for implementation, as a result of discussion during the week.

What would we have done differently?

Based on feedback, we might have built in more time for skills stations – for example airway management, NG tube placement, chest drain insertion and femoral line access. There is equipment to provide this training on the Unit, however we opted to focus on more simulation training for our week.

Any further efforts to keep groups small and reflective of typical team configurations would have had benefits too, although the feedback indicated that most of the time this was achieved.

We also found – as do organisers of similar training – that running a week can be tiring!  Inevitably, there is a bit of running around before and during the week, to sort out equipment, printing documents and keeping a track on the programme.  Two of us kept an eye on this, and our advice to anyone considering running a training week would include the importance of running the week as a team, with adequate time to oversee the logistics!

What about funding?

We used local training funding to free up time in order for two Arran clinicians to attend the Faculty Development Course, as well as some admin time required before, during and after the training week. Funding was also identified for GP locums – and this, combined with restricted leave during the week – meant that we were able to maintain normal service whilst maximising participation in the training scenarios.

The crucial advantage that we had by involving ScotSTAR teams is that they were able to fund their input via their own team outreach budgets – this is centrally funded with the aim of supporting rural clinicians, and so the conversion factor between local funding and the ‘worth’ of the week was 3-4 (i.e. we gained nearly four times as much value from the local funding required to organise the week).

Interested?

The SMMDP programme ran a fantastic, relevant- and fun – one day course on obstetric emergencies for us. Twenty staff from all disciplines attended.

David Hogg (GP) and Ailsa Weir (Senior Charge Nurse) oversaw the week of training. We can both be contacted via Arran War Memorial Hospital if you wish to find out more about our week. Lynn Hardie (Mobile Skills Unit Project Officer) was instrumental in organising the unit to be available, and our attendance at the Faculty Development Course. Lynn’s contact details are available on the MEN website.

In terms of team contacts, Sandra Stark (Nurse Consultant, ScotSTAR Paediatric Team) and Kate Silk (Programme Administrator at SMMDP) were our key links and very helpful in setting up the training. Every rural area in Scotland has an EMRS ‘link consultant’ and this should be the route that EMRS involvement is requested. In our case we were grateful to Dr Drew Inglis and Dr Doug Maxwell for their input.

If you are keen to consider a visit to your local area, contact the MSU team in the first instance, and they will be able to advise on availability, and advise on how to set up an appropriate programme of training.

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