Transcript Document

CLINICAL SKILLS
Managed Educational Network
Excellent skills for excellent care
Exploring the role of Tactical Decision
Games (TDGs) as a novel method of
teaching Non-Technical Skills (NTS)
Iain Drummond
University of Edinburgh/NHS Fife
Quality Education for a Healthier Scotland
Background - 1
• GMC Tomorrow’s Doctors (2009) key
outcomes include:
• 1) “The ability to provide immediate care
in medical emergencies.”
• 2) “…to make clinical judgements and
decisions based on the available
evidence, in conjunction with colleagues
and as appropriate for the graduate’s
level of training and experience. This
may include situations of uncertainty.”
Quality Education for a Healthier Scotland
Background - 2
• Challenging transition between Year 5 MBChB
and FY1
• Acute care is a particularly challenging area:
• WHO Definition (2013): “….promotive,
preventive, curative, rehabilitative or palliative
actions, whether oriented towards individuals
or populations, whose primary purpose is to
improve health and whose effectiveness
largely depends on time-sensitive and,
frequently, rapid intervention.”
Quality Education for a Healthier Scotland
Background - 3
• To provide optimal acute care doctors
must demonstrate effective NonTechnical Skills (NTS) behaviours:
• NTS: “the cognitive, social and
personal resource skills that
complement technical skills, and
contribute to safe and efficient task
performance”.
Quality Education for a Healthier Scotland
Acute Care Nontechnical skills (NTS)
Categories
1) Situational Awareness
Elements
Information gathering
Recognising and understanding
Projection to future states
2) Teamwork
Speaking up
Establishing a shared understanding
Establishing a team
3) Decision Making
Generating options
Balancing options
Reviewing of decisions
4) Task management
Prioritising tasks
Maintaining accepted standards
Being prepared
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for a resources
Healthier Scotland
Identifying
and utilising
Tactical Decision Games
(TDGs)
• Low-fidelity classroom-based activities
designed to increase proficiency in NTS
• Developing emergency scenario with
time limited period to decide on a course
of action
• Group come to decision regarding
course of action and feed decisions back
to facilitator and other groups
• Facilitator-led discussion around decisions
made and rationale underpinning
decisions
Quality Education for a Healthier Scotland
Features of TDGs
• Time-limited/pressured
• Conditions may change within scenario
• Intentionally ambiguous/no “right or
wrong” answers
• Participants may “follow-through”
decisions made
• Participants make difficult high-stakes
decisions in a team in a safe environment
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TDGs use in safety-critical
industries
• Originally developed in a decision skills
training programme for US Marine
Corps squad leaders
• Subsequently used in oil and gas
drilling industry, Scottish Prison Service,
nuclear power industry, military (and
others)
• Medicine – limited to unpublished work
only
Quality Education for a Healthier Scotland
TDGs – participant experience
from other industries
 Helpful in making difficult decisions under
time pressure and uncertainty
 Improved team performance
 Improved confidence
 Less reliance on SOPs
 More willing to take risks
 Learning from experience of others
 Gaining insight into role of others
 Useful feedback on performance
Quality Education for a Healthier Scotland
Aim of Research Project
• To explore the role of Tactical Decision
Games (TDGs) as a novel method of
teaching Non-Technical Skills (NTS) to
final year medical students
Quality Education for a Healthier Scotland
Phase 1 Objectives
• 1) To explore the feasibility of using
TDGs as a novel teaching method with
final year medical students.
• 2) To explore how to use TDGs most
effectively to teach NTS to final year
medical students
Quality Education for a Healthier Scotland
Provisional Phase 2
Objectives
• 2A) To investigate whether
participating in TDGs subsequently
influences NTS behaviour (in an acute
care setting)
• (If it does) to explore in what ways
participating in TDGs influences NTS
behaviour
• 2B) To develop medical TDGs
Quality Education for a Healthier Scotland
Phase 1 Methodology
• Action research study; students as co-creators
• Informed by pragmatic and constructivist
epistemology
• 2 generic TDGs, acute care simulation and
focus group
• Short presentation and discussion around NTS
between TDGs
• TDGs/simulations video recorded and focus
groups audio recorded and transcribed
• Iterative process as findings of 1 cycle inform
development of the next
Quality Education for a Healthier Scotland
Phase 1 Data Analysis
• Thematic analysis of focus group data
and participant observation in TDG
sessions
• Generic/medical/mixed games
• Length/format of sessions/size of groups
• Pre-assigning roles
• Active and passive participation
• Feedback
• Ambiguity and uncertainty
• Consequences
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Phase 2 Methodology
• Will be informed by results of Phase 1
• Potential use of Behavioural Marker
System (BMS) to evaluate NTS
performance following TDG
participation
• Potential development of medical
games in an iterative process
Quality Education for a Healthier Scotland
Summary
• NTS account for 70-80% of errors in
safety critical industries
• High-fidelity simulation is one means of
developing NTS but is expensive and
faculty intensive
• TDGs represent a potential low-fidelity,
affordable and sustainable alternative
method of teaching NTS
Quality Education for a Healthier Scotland