Europe leading the way

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Europe leading the way

• Stefan Mönk
• Mainz University
• AQAI Simulation Center
• METI

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Who am I?
European Roots
Example DGAI
Example OPOSICION
Example ESICM
The future
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Who am I?

• Anesthesiologist, Specialist in Emergency
  Medicine, Chief Emergency Physician, 1997
  co-founder of Simulation Center Mainz University
• 2005 Sabbatical, co-founder of private Mainz
  Simulation Center AQAI
• 2007 Development, Education, Project Management,
  hired by METI
• Also former president of SESAM, the Society in
  Europe for Simulation Applied to Medicine

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Who are you ?

• UK ? Europe?

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Who am I?
European Roots
Example DGAI
Example OPOSICION
Example ESICM
The future
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1996

• Someone called my boss who asked
• There is a new technology, called simulation.
  Who wants to have a look? BTW it is in Florida.
• We met Stan. And Joachim and Willem. A few months
  later Marco.
• Later we met Vimal in Leiden (NL) and Sophus in
  Herlev (DK)

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SESAM

• Society in Europe for Simulation Applied to
  Medicine
• Founded in a bar in Copenhagen, ca. 1994
• Per Foege Jensen and Vimal Chopra
• Re-start in Phoenix ca. 1998
• Long before SSH

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Europes Firsts

• International society (SESAM)
• Paper on quality assurance (DGAI, Germany)
• Nationwide introduction (DGAI, Germany)
• Compulsory training (The Netherlands)
• NAMS fka SUKS -) (UK)
• An international instructor course

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Some contributions from Europe

• Stirling, UK ANTS
• Anesthesia Non-Technical Skills Scoring System
• Herlev, DK Sophus
• Anesthesia Simulator
• Leiden, NL LAS
• Leiden Anesthesia Simulator
• Mannheim, GER Cathi
• Coronary Angiography Simulator
• Oslo, NOR SimSurgery
• Surgical simulators
• Hamburg, GER ESI
• European Surgical Institute (Johnson Johnson)
• Granada, Spain IAVANTE
• Large training center (government-run)

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METI A US company?

• Sarasota, Florida, right?
• PACT from Stirling, Groningen, Berlin, Brussels
• PNCI UK Version
• ICP from Bologna
• Drugs from Mainz
• International customer support AQAI, Mainz

Historically, Simulation seems to be European
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Who am I?
European Roots
Example DGAI
Example OPOSICION
Example ESICM
The future
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DGAI facts

• DGAI German Anesthesia Society
• About 10.000 members
• 2002 conditions
• Money
• Change of law ? anesthesia became a major topic
  in undergraduate education
• Lack of anesthesia specialists
• Interest in education in the executive committee

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DGAI facts

• 2003 35 / 38 medical schools received an ECS
• Conditions
• Undergraduate education
• Warranty program
• No commercial use
• 2 ECS as German spare
• METI - DGAI project coordination Mainz

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DGAI Goals

• Improve undergraduate education
• Increase anesthesia role in undergraduate
  education
• Improve attractivity of anesthesia as a speciality

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DGAI project key elements

• Central coordination
• Shipping ? testing ? installation ? training
• Education process
• Local trainings
• Regional meetings with training
• Central meeting with programme discussion

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MME
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MME PhD
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PACT
MME
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DGAI facts (DAC 2008)

• Undergraduate education 100
• Specialist training 68
• Anesthesia subspecialties
• Intensive care 27/38
• Pain medicine 28/38
• Palliative medicine 6/16

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Simulation exposure
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German university hospital anesthesia
departments (DGAI) 2007
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Ranking

• Anesthesiology coordinates emergency medicine
  training in 90 of medical schools
• German medical schools allocate money on the
  basis of the ranking of courses.
• The ranking is based on data from the students
  (questionnaires)
• 63 of anesthesia departments improved their
  ranking since 2003
• 92 of them attributed this to the ECS

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Recruitment results

• 36 of universities saw an increase in PJ in
  anesthesia, a major source of resident
  recruitment
• In 80 of PJ the simulator experience has
  influenced the decision towards anesthesia

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Who am I?
European Roots
Example DGAI
Example OPOSICION
Example ESICM
The future
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OPOSICION 2007

• Using simulation to select medical professionals
  for the Andalusian public health system

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OPOSICION

• Job contest on European level to select medical
  professionals for the Andalusian public health
  care system.
• Written test
• Practical exam
• Consideration of previous working experience
• In 2007 more than 4000 professionals applied in
  42 medical disciplines.
• For the first time the ministry of health defined
  that practical exams will be realized using
  simulation technology.

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Fundacion IAVANTE, CMAT

• IAVANTE Foundation of the Ministry of Health of
  Andalusia
• To facilitate development and training of medical
  professionals through innovative methodologies
• CMAT Surgical training, anesthesia training,
  emergency training and social skills.
• ORs, skill trainers, CBT rooms, lecture halls,
  laboratories, scenic simulations.

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OPOSICION?

• The government decided to use CMAT for the
  anesthesia and intensive care assessment center
• This is unique in Europe!

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CMAT
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METI HPS choice

• The reason for this was that due to the
  physiologic modelling implemented in the
  simulator and the possibilities to prepare the
  cases, the simulator can automatically react to
  the particiants actions. This enables us to
  provide a realistic and standardized setting and
  by this facilitate an objective and fair contest
  for the participants.

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HPS
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Practical conduct

• Conducted parallely on 3 METI HPS
• Physician operators (no previous HPS experience)
• 1 nurse in the OR, controlled via headset
• 410 contestants in 7 days (12 hours) of
  uninterrupted operation

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Contestants
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Practical conduct

• Evaluation through a jury of reknowned
  specialists denominated by the Andalus ministery
  of health
• The contest and the jurys evaluation was
  monitored by a representative of the local
  medical professionals union

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Judges
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Practical conduct

• Choice out of two cases that changed daily
• Standard patient file for briefing including
  information such as patient history, x-rays, or
  laboratory results
• The judge evaluated the performance based on a
  predefined scheme on mainly procedural and
  technical skills

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Control Room
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After the contest

• No debriefing, no diagnosis
• Printouts of the logfiles were stored as proof
• The judges evaluation summed up to a number
  reflecting the performance of the contestant
• Based on outcome of the overall contest, job
  offers in the public health system in Andalusia
  were given

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OPOSICION 2007 Results

• Positive results in questionnaires by
  contestants.
• This has been the first time in Europe that
  medical professionals had a practical exam on
  simulators on a large scale
• This method may improve the process of selection
  of the right candidate and may eventually
  contribute to a better health system.

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Who am I?
European Roots
Example DGAI
Example OPOSICION
Example ESICM
The future
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ESICM

• European Society for Intensive Care Medicine
• Ca. 4.000 members
• Educational interest
• CoBaTrICE Comptenecies
• EDICM Diploma
• PACT Learning material

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European IC training

• 18 of 21 countries had formal training
• 12 offered multidisciplinary entry
• 6 open only to anaesthesia
• Programmes 18 30 months. Median 24
• 18 countries offer accreditation
• Assessment of competence variable
• Intensive care training and speciality status in
  Europe international comparisons. Bion J.F.,
  Ramsay G., Roussos C., Burchardi H. Int. Care
  Med. (1998) 24 372-377

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Why can simulation help?

• Training variable
• Trainees work shorter hours
• Differing specialty backgrounds
• Differing specialty cultures and practices
• Wide variety of clinical pathologies
• IC team includes
• Nurses
• Respiratory therapists
• Other health professionals
• Patient safety

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Aims

• Improve patient care by improving training
• Ensure efficient simulation training in intensive
  care
• Utilising
• experts in intensive care
• experts in simulation
• experts in education
• Employing TTT seminars

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Supporting materials

• Using charts from local clinical facilities
• Utilising authentic blood test result forms,
  ECGs, and radiographs
• Giving the SCE patients identities and
  demographics which are recognisable to the
  learners
• Briefing the teaching team members, if any, that
  are needed to take part in the simulation

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Competent instructors

• Experienced clinicians in the ICU subject matter
  experts.
• Familiar with the educational material and the
  educational programme within their hospital,
  region, country
• Able to focus on both technical and non-technical
  skills in all aspects of simulation
• Training in running Intensive Care simulation is
  available through the ESICM/SAINT TTT course.

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Team

• Lia Fluit, University Nijmegen Medical Centre
• Torsten Schröder, Berlin Simulation Center
• Götz Bosse, Berlin Simulation Center
• Graham Nimmo, Stirling Simulation Center
• Ben Shippey, Stirling Simulation Center
• Martin Grapengeter, Groningen Simulation Center
• Joost Regtien, Groningen Simulation Center
• Stefan Mönk, Mainz Simulation Center

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History

• 2003 ESICM open meeting Amsterdam PACT and
  simulation
• 2004 Jan Workshop in Stirling
• 2004 Sep Berlin Stirling simulation
• 2005 ESICM in Amsterdam Gromingen, Berlin,
  Stirling simulation ? GroBerLing
• 2006 January formal agreement ESICM, GroBerLing
• 2006 Porto (SESAM) SAInT
• 2006 ESICM in Barcelona official part of the
  programme
• 2006 HPSN Mainz MOU ESICM METI
• 2007 TTTs, workshops, meetings in Stirling,
  Copenhagen, Berlin, Groningen
• 2007 October ESICM in Berlin official part of
  the programme
• 2008 Product launch

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PACT
Patient-Centred Acute Care Training
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CoBaTrICE

• 'Competency-Based Training in Intensive Care
  Medicine in Europe'
• Minimum standard of knowledge, skills and
  attitudes required to be a specialist.
• Internationally applicable but able to
  accommodate national practices and local
  constraints.
• 102 competency statements grouped into 12 domains

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Workflow
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METI / Mainz competencies

• Project coordination e.g. German anesthesia
  society introduction of simulation into
  undergraduate training project
• Programming e.g. Australasian College for
  Emergency Medicine Training
• Learning programme developmente.g. Programme for
  Nursing Curriculum Integration

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Result Content
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Design
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Structure

• Synopsis
• Target Learners, Learning objectives, CoBaTrICE
  competencies
• Equipment, supporting material, monitoring,
  simulator setup
• Teaching team, duration
• History, patient data (laboratory, physical)
• Sugested debriefing technical, on-technical
  skills
• Scenario
• References

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Future

• ESICM, METI, SAInT will collaborate in future
  developments to maintain and enhace the PACT
  Human Patient Simulation Learning Module
• Step 1 Modules 20-40
• Step 2 Maintenance of modules 1-20
• Roll out of TTT course to ensure quality

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Who am I?
European Roots
Example DGAI
Example OPOSICION
Example ESICM
The future
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What do I expect?

• Some ideas

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Eastern Europe

• Poland
• Univ. Warsaw, Anesthesia Dpt.
• Hungary
• Anesthesia Society, Budapest
• National Training Institute, Budapest
• Semmelweis Nursing School, Budapest
• Nursing School, Pecs
• Bosnia, Czechia, Rumania, Serbia, Slovenia

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Eastern Europe Airmed 2008

• May 20-23, Prague
• Critical Care Simulator Competition
• 9 Teams
• 5 Czechia
• 2 Canada 1st place
• 1 Hungary second place
• 1 US

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European Standards

• Definition of quality for training and education
  through simulation
• R-1 Instructor Competencies
• R-5 Simulating the certification of instructors
  - what would a "SESAM certified instructor" need
  to know, what skills would he/she need, how could
  that be assessed?

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More focus on education

• Masters of Medical Education even in Germany!
• 5 cohorts
• Active search for graduates
• Many participants from simulation groups
• Education accepted as work
• Accepted as field of research

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Societies will increase thepromotion of
simulation

• Guidelines and society activities
• E.g. PACT
• E.g. ERC
• E.g. Sedation for non-anesthesiolgists
• E.g. Trauma Course (ETC) pre-conference HPSN in
  November

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Europe as role model

• More visitors from
• Asia
• Africa
• Australia

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We will

• Maintain a leading role
• Be looked at
• Be a bridge between the continents
• Establish guidelines
• Make firsts
• Establish assessments
• Address shortage of workforce with simulation
• Keep the momentum through growth in Eastern Europe

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ONLY if we

• Increase the use of simulation
• Explain the advantages
• Keep spreading the message

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So? Is simulation here to stay?

• Why should we care!
• DGAI
• Tool Yes
• Content None
• Educational Method None
• IAVANTE
• Tool Yes
• Content None
• Educational Method None
• PACT
• Tool Yes
• Content Yes
• Educational Method None
• Where is nursing?