Chest Tube Simulations at Rural Medical Conference

by Tia Renouf

Our last 2 blogs featured simulation on the move: in Malawi, and shipboard in the North Atlantic Ocean. This November we are back in St. John’s, at our inaugural rural emergency medicine skills refresher course. About 30 doctors from throughout the province attended our 2-day workshop for simulated hands-on chest tube training, ultrasound, and a few didactic lectures.

This year’s course resembled a similar one we gave in St. Anthony last year. Doctors there wanted to practice surgical airways and chest tubes, so we got to work trying to find equipment to take. That was harder than we anticipated. It was logistically impossible to bring a computerized human mannequin from St. John’s to St. Anthony, so we got out our simulation cookbook and learned how to make simple chest tubes and surgical airway task trainers

http://www.med.mun.ca/getattachment/56d9cf6a-58af-43a8-92b0-440c87dc9df8/DIY-Simulation-Cookbook.pdf.aspx

This has become a common theme in our distributed medical school: how do we deliver the same high quality simulation teaching to students wherever in the Province they may be? We know that simple task trainers produce good teaching as long as educators use sound pedagogy. The glamour problem is another thing. It’s just not sexy to teach chest tubes with pork ribs or make necks with throwaways from hospital bag valve mask equipment.

But in St. Anthony and St. John’s, we found it really did not matter. Physicians and students so wanted to perfect and maintain HALO (High Acuity Low Occurrence) skills that they suspended belief and got to work on our homemade task trainers. After all, that’s all part of simulation…. it’s just a matter of how much belief to suspend. All were supremely engaged. An observer from another planet would have thought it was the real thing, such was the enthusiasm and concentration in the room.

The beauty of these task trainers is that learners take them home to practice in their own work places, where they can support one another and work inter-professionally.  Many questions emerged from these experiences and I hope we can use them to inform next year’s refresher course: what is the best way to teach surgical skills? Should we use checklists? How do we provide opportunities for deliberate practice and debriefing? In what way and how often should we reinforce this teaching, in order for rural and remote physicians to feel comfortable with their HALO skills? Can we do it virtually? Perhaps training-the-trainer is an effective method to maintain one’s own skills while teaching others in an ever-flowing cascade.

We are already planning next year’s conference. We will use eggs as eyeballs and turkey legs for interosseus needles. We also have a little secret up our sleeves. Spoiler Alert: some new and innovative technologies are being developed in our lab but you’ll have to wait till next month to hear about it.

Tia Renouf