With its 24 clinics, 16 departments, six institutes and 1400 beds, University Hospital Erlangen comprehends every field of modern medicine. Research results from Erlangen are setting standards for the prevention, diagnostics and therapy carried out at the hospital where 1400 employees have their daily work.
From skills training to in situ simulations
Bringing along the bag valve mask when transporting patients from the operating theater to the recovery room is not of much help when the doctor in charge is not capable of using the device. Chief Pediatrician Michael Scroth says this example demonstrates an inability, seen in new doctors especially, to provide safe and effective patient care when it is needed the most.
Although skills training had already been implemented at Erlangen a decade earlier, Mr Scroth was convinced that having collegues train together, using the tools and equipment they normally use, would generate much better results. A SimBaby simulator was purchased in 2007 and the next step was finding a place to set up the training equipment.
Obtaining training facilities
By sparing part of his personal office, Dr Scroth was able to provide the few square meters he needed to set up the equipment. Two extra walls were put up to facilitate a small simulation room in one corner, and the opposite corner of the office was designated as the debriefing and control area, from which colleagues could observe and learn from their peers' performance via a screen placed on the wall.
First German hospital to start in situ training
''I thought I was kind of late implementing in situ training in 2008, but it turns out that I was the only one up until recently here in Germany.'' Dr Scroth explains that his colleagues were skeptical at first, worrying that there wouldn't be enough time to train, even with the training equipment located right on the ward. He has shown, however, that the localized training is both efficient and effective:
''The participants are very quickly made aware of their personal limitations - and it's much easier for younger doctors to accept the need to train when they see the experienced ones are doing it. Exposing ones own shortcomings becomes less embarrassing that way.
They also learn to open their eyes; now they look at the child (the simulator) and not the monitors, like they did when they first started fully immersive simulation training. The participants really experience that they've 'been there!' It's the same crash cart, they know the equipment.
In situ training enables us to act on the spot, so to speak. We can take colleagues aside and quickly address incidents that occurred only moments earlier. By tailoring the scenarios to emergency situations that play out in real life, learning objectives that have become apparent along the way are hence being addressed.
It is amazing to see how students remember most of the scenarios they go through years later. After completing 80% of the curriculum, the participants have more or less been through what they need to know.
This training enables young doctors to identify emergency situations sooner and to understand that they are able to bridge situations until a senior resident appears. It is an enourmous gain of confidence.''
Dr Hans-Georg Topf, also simulation instructor at Erlangen, is just as enthusiastic. ''What I like most is that you can start any scenario at any skill level, with any group of participants. Students say the training gets their knowledge 'on the road.' Instead of thinking about what they would or should have done in a situation they now do it.
University Hospital Erlangen has developed a set of scenarios that reflect the clinical conditions and emergency situations most frequently seen in the pediatric and neonatal wards. Interaction and team work is highly focused. The scenarios include:
- Basic life support
- Basic neonatal life support
- Bradycardia in neonates
- Bronchiolitis and respiratory disorders
- Cardiac arrest
- Comotio cerebri
- Exsiccosis and gastroenteritis
- Metabolic disorders
- Neonatal infections (SIRS)
- Tachycardia (SVT) in neonates
Participants, frequency and duration of training
All doctor employed at the Pediatric, Neonatal and Adult Intensive Care units are required to perform at least one facilitated simulation training every three months.
Daily training takes place whenever there is time and these sessions are mostly conducted in the designated training facility on the ward, while others take place in the Emergency Department and elsewhere in the Pediatric Hospital.
Doctors and nurses train together on occasion, but the majority of participants are doctors, medical students (on week days) and external clientele (on weekends).