Medical Simulation Training [Re-release] (11 Oct 2023)

SPEAKER_00 0:00

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SPEAKER_02 0:24

Hello everyone and welcome to this week's episode delivered to you by the Royal College of Physicians of Edinburgh Trainees and Members Committee. My name is Dr. Jonathan Bargett, and I am an acute and general internal medicine trainee based in South East Scotland. Today I am delighted to welcome Dr. Vicki Tallantar. She is an educational coordinator at the Scottish Centre for Simulation and Clinical Human Factors and an Associate Postgraduate Director for IMT Simulation Training. Welcome, Dr. Tallantar.

SPEAKER_01 0:57

Hello, Johnny. Nice to meet you.

SPEAKER_02 0:59

I'm delighted to have you on the podcast today, Dr. Tallantar. So I I think one of the things that we at the college are really trying to promote is access to training in medical and clinical education. And I'd like to ask you with your background in this area, why is this so important for our internal medicine trainees?

SPEAKER_01 1:18

Gosh, well, I suppose that most of the audience listening to this will already appreciate the importance of education in our profession. I mean, the Goodenough report back in 1944 said that properly planned and carefully conducted medical education is the foundation of a comprehensive health service. And I really do believe that. I think education at every stage is pivotal, not just to developing skills, but also to developing attitudes and identities that we carry with us throughout our careers and beyond.

SPEAKER_02 1:52

So you talked about knowledge and skills and attitudes, and these sound like their key principles in medical education training. For our listeners, can you tell us a bit about how you got into this area of medical education?

SPEAKER_01 2:06

Yeah, well, I suppose everybody's journey is different. And I guess mine started really, I guess, back in 2000 when I did an intercollated degree actually in medical ethics down in Bristol. And what that year kind of opened my eyes to is all sorts of new ways of looking at the world, the importance of actions being interpreted within a sort of social and emotional context rather than in isolation, as we unfortunately still see in some SEA reports. But I think really I sort of then went back into finishing my degree in Edinburgh and of course my junior training. And then in 2009, I applied for a fellowship at the University of Edinburgh, a fellowship in medical education that was two years long, fellowships that are still running. And really that was, I guess, the transition point in my career in terms of the skills that I developed over those two years, the relationships that were formed. I undertook my doctorate, and really over the last 12 years I've I've built on that.

SPEAKER_02 3:09

That that sounds like that was a great opportunity for you. What kind of skills did you learn during your fellowship, Dr. Talentare?

SPEAKER_01 3:15

Well, I was really immersed in the university in Edinburgh and um got to work alongside some really experienced educationalists. I never liked that term, but doctors who'd really immersed themselves in medical education and made it a big part of their careers. And so I learned lots and lots of teaching skills. I learnt that in lots of different formats and spent a lot of time with medical students. But what I also learnt is an approach to medical education research through a lot of reading, some courses that I went on, and some mentorship that I was lucky enough to have about the development of some research skills that were really fundamental to doing the sort of work that I wanted to pursue, and through that developed the skills to complete a doctorate in medical education, which was the first medical education MD in Edinburgh. And I'm really delighted that subsequently that's continued, and there's there's maybe 11 or 12 been awarded since I did mine. And so it's absolutely brilliant that that level of scholarship has continued within the department. But at the time it was quite a battle to be allowed to pursue that course, and but it was definitely one that was worth fighting. And the skills that I developed then have allowed me to go on and continue to do the education research that I do now.

SPEAKER_02 4:32

Really interesting to learn how your journey into medical education has progressed, Dr. Alantar. And I guess one of the key values that the Royal College of Physicians of Edinburgh has is promoting time for research and training. And I guess one of the things that I'd like to follow on from what you said is how can our foundation year doctors and our general internal medicine trainees pursue an interest or explore an interest in clinical and medical education now?

SPEAKER_01 5:00

I mean, if things are difficult just now with the pandemic, but hopefully things will be more back to normal soon. And I think there's loads of different ways to get involved. I would say the key thing is probably finding someone who, if not formally a mentor, someone who will at least help you along the journey in the early stages of opportunities to teach, which is really I started teaching on ALS courses and things like that. And so opportunities to teach if you're interested in doing some research, then someone who's got some experience in that field. And then there's some really good courses that you can go on. There's sort of week-long courses that will hopefully start up again soon. Um and then there's some specific medical education training that uh research training that you can do. So there's there's loads of ways to get involved. I guess one of the first steps for me being an acute physician was through ALS, but that's certainly not the only route. And I guess picking people's brains who are involved in education as to how they started would really be helpful for trainees wanting to get involved.

SPEAKER_02 6:04

So you mentioned that there are some courses, such as um going through advanced life support. What other courses would you recommend?

SPEAKER_01 6:11

Well, it depends what sort of education people are interested in. In terms of getting involved in medical education research, then ASME, the Association for the Study of Medical Education, runs some really good research-specific courses. And we've just launched one ourselves because there wasn't one in Scotland, but we've launched getting started in simulation-based research course at the National Simulation Centre in Larbet. So if you want to get involved in teaching simulation rather than researching simulation, then there's lots of really good faculty development courses. Lots of health boards run them locally, but there's also availability at the National Simulation Centre as well in Fourth Valley. So there's there's lots of, it depends on what type of education. If people want a broader approach, then there's certainly a summer school at the University of Edinburgh that offer really broad education, um, educational approach with introductions to lots of things like designing OSCIS and assessment processes. So it really depends on what particular facet somebody's interested in.

SPEAKER_02 7:13

And I think that's really good for the listeners to to know about what's out there and what's available. I think the University of Edinburgh also does a medical um education or clinical education master's programme, which I would like to really highlight as well. I guess what I'd like to ask you in particular, then, Dr. Hansor, is about your simulation research. So just for the listeners, what is medical simulation as a starter?

SPEAKER_01 7:36

Well, I think most trainees and consultants now are familiar with what simulation is and the role that it can play, but essentially it's mimicking either a procedural skill or some form of communication or some form of immersive scenario with plastic mannequins so that people can rehearse these high-stakes actions, procedures, communications, whatever it is, before they have to do it for real in the workplace. And then also alongside doing it for real in the workplace, they can further enhance their skills by really deliberate practice. So having someone watch and critique and then perhaps rehearse again what you're doing. So even for quite experienced clinicians, it can be invaluable for somebody to really dig in detail into exactly your decision-making processes and a lot of other non-technical skills, which we do find it really hard to rehearse and critique within our clinical practice.

SPEAKER_02 8:36

Yeah, and I think you mentioned the pandemic and how that has interrupted medical education and training as a whole. But in terms of giving our trainees opportunities to explore this, what would your advice be for them now if if they want to explore their interest or whether they are interested in medical simulation?

SPEAKER_01 8:56

So there's lots of ways to get involved. Virtually all health boards will be running simulation programmes. There's foundation simulation, certainly running across Scotland, and there are lots of simulation opportunities. Most health boards will have a lead for simulation. So it's finding out who that is, getting involved through them would be the first port of call to do it locally. There's also the National Simulation Centre who run faculty development courses to teach the basics of teaching of facilitating simulation, and then there's lots of things that you could get involved in there as well if you're near enough. There's really awesome simulation stuff going on in Aberdeen and Inverness, and there's loads of people up there who are heavily involved, particularly from a surgical perspective in Inverness. And so, really, for any specialty that you're involved in, you'll be able to find someone within your health board or near enough to your health board who's keen to get you involved in their simulation activity and hopefully get you upskilled in the early days of facilitating.

SPEAKER_02 9:59

So I think it's really useful just to get an insight into how simulation training works. And I guess through my career I've experienced it as an undergraduate and a postgraduate. And sometimes simulation can give the trainees a bit of fear, or um maybe sometimes people relish in it. What would your advice be in how we we approach simulation?

SPEAKER_01 10:22

Well, I mean, absolutely, I remember doing it as a medical student and being terrified, and that's absolutely not the way that I run simulation and that most of my colleagues run it. You know, I'm always very, very clear at the start of the day that the simulation should be a formative learning exercise. I I'm not involved in simulation for assessment, although it does exist, but you have to be very careful around how that's done and the validity of what you're doing. The taught simulation that I do is an opportunity for us to really explore what aspects of our practice we need to work on to be better doctors. And I think the only way that you can do that is to let your guard down, to allow yourself to complement your performance when that's you know, when that's indicated, but also be able to critique yourself and others in a positive and helpful way so that we can identify the opportunities for improvement and really capitalise on them.

SPEAKER_02 11:20

It sounds like simulation training should or could be an integral part of training in general medicine and internal medicine. I'm aware that it's already started to be incorporated into the new internal medicine training curriculum.

SPEAKER_01 11:35

When CMT changed to IMT in August 2019, we could see that on the horizon perhaps a year or so before then, and really took inspiration from the surgeons who had implemented a really comprehensive simulation program within IST training in Scotland. And I and a few and other people who were involved met up with the surgeons and really kind of dug into how they had managed to do that and developed a sort of roadmap for the way that we saw simulation fitting into the new IMT curriculum. And that was a lot of work over about a year in the run-up to the start of IMT, and that we were lucky enough to have our proposal to Scottish Government funded, and that work was really led by Claire Mackenzie, Neil McGowan, myself, and a few others who bid to Scottish Government and we were successful in having the first year of what we called IMT boot camp funded, and that ran from August 2019 to January 2020, and we put all 105 IMT ones in Scotland through that boot camp, which is a three-day simulation-based boot camp focusing on different aspects of what they would be required to do as IMTs. And the feedback that we got was just phenomenal. I was completely blown away by not just how much trainees valued the quality of what we were doing, but also how it gave them an enhanced sense of well-being, a very tangible identity that they were perhaps lacking before, and a sense of camaraderie that I think has turned out to be of really pivotal importance over the last 12 months or so.

SPEAKER_02 13:29

That sounds really great that that's coming into the training curriculum. And I guess I would have loved to have experienced that myself as a core medical trainee. Do you know if anything has been proposed about introducing medical simulation into the curriculum in other specialty programs within medicine?

SPEAKER_01 13:49

So I'm uh busy working away on IM2. We've just introduced a Skills Day in IM2 where we focus on more complex medical interventions. And now I'm designing and bidding for the simulation training plans for IM3, which are going to hopefully better prepare people for the medical registrar role that is so dreaded, understandably dreaded a lot of the time. And we really think that we can do something that's going to help people to make that transition a bit smoother. I don't know about other specialties at the moment. I think there's stuff happening in anesthesia, there's stuff happening certainly in surgery, and there's stuff being uh coordinated by Jean Kerr in psychiatry, but I can't tell you about other medical specialties, Johnny. I'm afraid I don't know about that.

SPEAKER_02 14:39

That's that's fine. And I think the key message that's coming through is that simulation training is really going to be coming alongside real life practice as a safe environment for learning. And I guess one of the questions that I would have for you is how can our trainees pursue their interest in this after they've gone through the training? What was your advice for our aspiring educationalists? I know you don't like the word educationalists as much. Um how can our medical trainees pursue their interest in this and follow in your footsteps?

SPEAKER_01 15:13

Well, I'm not sure I'd recommend following my footsteps necessarily, Johnny, but um but I think there's lots of inspirational people out there. I mean, I work with people from across Scotland, um, Fiona Farco in Lanarkshire, Neil McGowan, who I've mentioned in Glasgow, Kim Mill in Aberdeen, there's Jerry Morse up there, there's there's a whole cohort of uh surgeons doing amazing stuff up there too. And you know, I just think there's some there's such fantastic people, James Tiernan here in Edinburgh, who's leading the mastery programme, um, Nathan Oliver. I think just teaming up with those people locally is what I would say. There's such enthusiasts everywhere. You just need to find them and they will point you in the right direction. If you're wanting to start writing and publishing, my specific advice on that would be to take a little bit longer planning your project and a little bit less time doing it, because I quite often get involved when trainees present me with a whole load of data that they've collected when they weren't really sure what question they were asking. So I think that my overwhelming advice for research uh would be to take your time in planning, make sure you know what's out there in the literature, what questions have already been answered, and if that's the sort of area that people are keen to get involved in. Um if you're keen to get involved in SIM, there's loads of opportunities to first of all be trained properly in the methodology, which looks simple as a as a participant, but is really quite complex as a facilitator. And I I've been doing this for about 12 years, and I'm still learning all of the time, and I still make mistakes when I'm facilitating. And so there's a huge amount to learn and a huge amount to think about when you start. Try and go on a course, get some robust understanding of the methodology, and then just try and rehearse as much as possible. Try and take every opportunity to teach. I mean, I used to do that in my days off. I used to do it sometimes in annual leave, and that's not, I wouldn't recommend that now. I think we all need breaks, you know, we all need holidays perhaps more than I used to appreciate. But I think take every opportunity that you possibly can.

SPEAKER_02 17:24

That's really helpful advice, and I'm sure our listeners, our internal medicine trainees, our foundation year, and general internal medicine trainees will really appreciate that. What I'd really like to sort of close with is just your key take-home points and advice for our trainees going forward, having having just touched the surface of medical education, clinical education and simulation training.

SPEAKER_01 17:46

Difficult question, but I think probably in early days of being involved in medical education, there were things that um my research partner Sam Smith and I were told we couldn't do, we couldn't do a doctorate, we couldn't do an MD in medical education. And we, um in a very respectful but very tenacious way, really fought against that decision. And I think that if you really want to do something and you really believe that you're capable of it, then sometimes you don't accept no for an answer. And as long as that's done with respect for the institutions and the people involved, and the arguments are well thought out and coherent and non-emotional, then I think really sometimes you can get people in authority to change their minds. The other bit of advice that I would have for people is try to form a team. I I was really lucky. I did my fellowship with Sam, who who I formed a very good friendship and a very productive research relationship with, and have been publishing with now for 12 years. And um, subsequently, I've formed a group of trainees, and we all research and write together and have uh, and with that group, they've managed to publish about six different manuscripts now, and it's been really successful, mostly because they're all extremely motivated, bright individuals. But what really helps is the fact that we're working together, that you don't want to let other people down, you're not in this on your own, it's not research can be quite lonely, and so if you form a group or a group of people learning to teach sim, learning to facilitate, then I think that can be really helpful, and especially on those days when you're just feeling that it's all going a bit wrong, they're the people that can pick you up and make you carry on. So for me, that's been pivotal in my educational journey so far, and I hope that it continues that way.

SPEAKER_02 19:42

Thank you so much, Dr. Talentara. I think the key things that are coming through from chatting with you today are that mentorship, role models, teamworking, these key skills are really core of any specialty, but also medical education in its own right. Is there anything else you'd like to chat about and discuss?

SPEAKER_01 20:02

I mean, the only thing that I would add is that the trainees and members committee, I was secretary of that committee for a few years, and it was a big part of my um formative years in and really helpful in understanding educational structures, the college, where that fits in, what its role is. And you know, I know what hard work it is to be a part of that. I know in it's in most people's spare time, and I think you just all do such a fantastic job. So thank you very much.

SPEAKER_02 20:30

Thank you so much for for joining us, Dr. Tallantar.