Using simulation in continuing professional development (CPD) courses for local practitioners is uncommon in Korea. The aim of our study was to evaluate the responses of the local practitioners for a simulation-based short CPD course.
Following the targeted needs assessment of local practitioners, we developed and implemented a 3-hour simulation-based CPD course for the first 5 minutes of cardiac arrest in the resource-limited local clinics. We evaluated the participant’s responses to the course using a questionnaire.
During the 3-year implementation period, 115 practitioners participated in 10 courses, and 113 (98%) responded to the questionnaire. The overall course satisfaction (10-point scale) was very positive (10 in 93 [82.3%], 9 in 19 [16.8%], and 8 in 1 [0.8%]). The level (5-point scale) of recommendation to the others was also high (5 in 103 [91.2%] and 4 in 10 [8.8%]). Many participants positively commented on the authentic practical experience of the uncommon crisis in their contexts.
A simulation-based short CPD course for in-hospital cardiac arrest could provide an authentic practical experience for local practitioners working in resource-limited clinics.
After graduating from medical school, all physicians must continue lifelong learning for their professional practice. Continuing professional development (CPD) includes all activities that physicians undertake, formally and informally, including continuing medical education (CME), in order to maintain, update, develop, and enhance their knowledge, skills, and attitudes in response to the needs of their patients [
In 2014, with the foundation of the CME Accreditation and Evaluation Council, the Korean Medical Association (KMA) introduced mandatory credit and expanded the CME to the CPD [
The incidence of in-hospital cardiac arrest (IHCA) in local clinics has increased due to the increasing old age population and sedative use for endoscopy and cosmetic surgery in Korea [
The course participants were local practitioners working in cooperative clinics of a tertiary teaching hospital in Seoul. The medical referral center of the hospital has recruited participants via email in the second half of every year since 2017. The 12 practitioners participated in each course voluntarily.
Three emergency physicians with expertise in resuscitation and simulation education and an experienced simulation operations specialist (SOS) developed the course. The course development team developed a detailed consideration and application plan for the course according to the six-step approach of curriculum development [
In April 2016, the team conducted a meeting with four alumni practitioners to identify their educational needs and resource status in local clinics. After setting the goals and learning objectives, we aligned the educational strategies and assessment methods. Two pilot courses were performed for alumni practitioners of plastic surgery and internal medicine at the medical college-based simulation center. In the first half of 2017, in collaboration with the medical referral center, the team identified the educational needs of the cooperative clinics, and revised the simulation scenarios. After receiving three CPD credits from the KMA CME Accreditation and Evaluation Council, we implemented the first-year courses at the simulation center in the second half of 2017.
Before participating in the course, all practitioners voluntarily signed an informed consent after receiving a prior explanation about using the photographs, videos, and questionnaire along with a pledge of confidentiality for simulation training.
The ART course consisted of three sessions: (1) a brief lecture, (2) a hands-on practice workshop, and (3) a patient simulation (
The course evaluation was conducted with a questionnaire immediately after the course. The questionnaire consisted of (1) a 10-point Likert scale evaluation for overall satisfaction; (2) a 5-point Likert scale evaluation for the training time, instructors, teaching methods, educational environment, recommendations to others; and (3) written comments.
Quantitative data were analyzed with descriptive statistics. Two investigators (Y.M.K. and S.A.L.) repeatedly read qualitative data independently and extracted major themes using the thematic analysis [
Ten courses were implemented during the 3-year period, and 115 practitioners participated in the courses. The participants’ sex was male (n=64) and female (n=51) and the median age (range) were 50 years (range, 35–73 years). Specialties were internal medicine (n=41), pediatrics (n=22), family medicine (n=11), otolaryngology (n=7), ophthalmology (n=7), orthopedics (n=7), obstetric (n=5), dermatology (n=5), urology (n=4), general surgery (n=3), rehabilitation (n=1), and neurology (n=1).
The clinics operated by the participants were classified as clinics among the types of medical institutions, with a small number (less than five) of medical personnel and limited equipment.
Among the participants, 113 (98%) responded to the questionnaire. The overall satisfaction was very positive (10 in 93 [82.3%], 9 in 19 [16.8%], and 8 in 1 [0.8%]). The satisfaction level for the instructors was very positive (5 in 111 [98.2%] and 4 in 2 [1.8%]). For teaching and learning methods, responses were also positive (5 in 99 [87.6%] and 4 in 14 [12.4%]) and very positive (5 in 102 [90.3%] and 4 in 11 [9.7%]) for the learning environment. The level of recommendation to the others was also high (5 in 103 [91.2%] and 4 in 10 [8.8%]). Most participants evaluated that training time was optimal (n=112, 99.1%).
Most participants positively commented that they could have an authentic experience of the unusual crisis. They also mentioned repeated practice, connection to knowledge and practice, and an adequate proportion of instructors and learners as the good aspect of the course. Some participants wanted more diverse scenarios and team-based training with other staff members. In addition, some needed regular repeated training (
The ART course, a systematically designed simulation-based short CPD course for the first 5 minutes of IHCA, could provide authentic and practical learning experiences to local practitioners working at private clinics with limited resources. It would be an excellent example of how simulations can be effectively used for the CPD program on a specific topic requiring practical skill acquisition and maintenance for local practitioners.
Physicians’ CPD is not only a duty stipulated in the medical law but also an essential requirement for the self-development and self-regulation of medical professionals. It aims to promote and protect the public’s physical, mental, and social health. An effective CPD requires needs assessments, appropriate learning activities, and follow-up on learning [
The ART course was developed by faithfully following the guidelines for the judicious use of simulation technology in CME suggested by Curtis et al. [
Despite these strengths, there were some limitations to our course. First, we could not assess each participant’s performance with a validated tool due to the limited training time. Second, we only implemented two scenarios for patient simulation. It would fail to cover the educational needs of some participants. Third, although the simulation coordinators acted as the other personnel in the clinic during the simulation, the course participants were limited by physicians. Further efforts are required for the next steps, such as developing scenarios for more diverse situations and a team training course with other hospital staff members.
This is a collaborative project of the medical referral center of Seoul St. Mary’s Hospital and the START Center for Medical Simulation, College of Medicine, The Catholic University of Korea. We appreciate the faculty members of the medical referral center and the START center.
Hands-on practice room. (B) Minor surgery simulation room. (C) Endoscopy simulation room. (D) Waiting area simulation room.
The Time Schedule, Contents, Teaching and Learning Activities, and Assessment of the Airway Management and Resuscitation Training Course
Time | Contents | Teaching and learning activities | Formative assessment |
---|---|---|---|
20 min | Welcome and course orientation | ||
30 min | A brief review of current cardiopulmonary resuscitation guidelines and the concept of crisis resource management | Interactive lecture | Question and answer |
10 min | Break | ||
60 min | Situation awareness, identification of cardiac arrest, activation of emergency response team | Hands-on practice | Direct observation and corrective feedback |
Chest compressions and automated external defibrillator | |||
Bag-valve-mask & supraglottic airway devices (i-gel, laryngeal mask airway supreme) | |||
50 min | IHCA with shockable initial rhythm at the waiting area of the clinic | Patient simulation using rapid cycle deliberate practice method | Direct observation and debriefing (pause and discuss/rewind) |
IHCA with non-shockable initial rhythm at the endoscopy or minor surgery room | |||
10 min | Course evaluation and wrap-up | Questionnaire |
IHCA: In-hospital cardiac arrest.
Main Themes Derived from Written Comments
What was good | What could be improved |
---|---|
- Authentic experience | - Short training time |
- Repeated practice | - Limited simulation scenarios |
- Connection to knowledge and practice | - Needs for team-based training with other staff members |
- An adequate proportion of instructors and learners | - Needs for regular repeated training |
6-Step approach | Detailed considerations | Application plan |
---|---|---|
1. Problem identification and general needs assessment | A. Problem characterization | A. Cardiac arrest in the local clinic: legal & economic problems |
B. Current approach | B. Lecture-based knowledge acquisition | |
C. Ideal approach | C. Simulation-based practical training | |
D. Gap analysis | D. Needs for a simulation-based practical course | |
2. Targeted needs assessment | A. Target learners | A. Local practitioners in the resource-limited setting |
B. Targeted learning environment | B. Out-patient clinic waiting area, endoscopy, and minor surgery room | |
3. Goals and objectives | A. Broad goals | 1. To identify the cardiac arrest and activate an emergency response team |
B. Specific measurable objectives | 2. To apply airway management and core resuscitation skills effectively during the crisis | |
3. To apply the CRM principles during the crisis | ||
4. Educational strategies | A. Content | 1. Brief lecture on current resuscitation guidelines and the concept of CRM |
B. Methods | 2. Hands-on practice for related skills using low-fidelity simulators | |
3. Patient simulation using the rapid cycle deliberate practice method including stop-action debriefing. | ||
5. Implementation | A. Political and administrative support | - Institutional course certificate |
B. Resources | - Alumni association and hospital referral center | |
C. Identification and address of barriers | - Simulation center | |
- Experienced facilitators and simulation specialists | ||
D. Administration of curriculum | - Recruitment of the participants and scheduling | |
E. Introduction to curriculum | - Course fee | |
- Time constraint | ||
- Korean Medical Association continuing medical education credit | ||
- Course coordinator | ||
- Email recruitment | ||
6. Evaluation and feedback | A. Individual assessment | - Checklist and debriefing plan |
B. Program evaluation | - Post-course survey (questionnaire) |
CRM: Crisis resource management.