|Implemented in this survey?|
The QHSDC is a government sponsored centre which aims to assist in the development of a safer, flexible and effective health workforce. An important goal is to provide a springboard for the fermentation of ideas to enable the production of innovative and research-based courses whose outcomes are properly evaluated. It encompasses mock operating theatres, laboratories and virtual reality skills areas and aims to be self funding through providing educational courses to health care professionals.
The objective of the Queensland Health Skills Development Centre (QHSDC) is to assist in the development of a safer, more flexible and effective workforce to meet the challenges of working in the 21st century. This will be achieved by:
The centre is the first State sponsored facility of its type in the region and is intended to be a useful resource for the whole State. It is focused on skills development and innovation in the
areas of surgery, anaesthetics, communications, human factors, patient safety and health imporvement sciences.
Although the Qld government has allocated resources for the capital costs of setting up the centre, it is intended that the Centre will be self-funded from the profits made by delivering educational courses to Qld Health staff, and the health industry generally from other Australian states, New Zealand and SE Asia.
The objectives of the QSDC are to:
The Qld government and Qld Health have incentives to fund the development of the QSDC which relate to attracting and retaining skilled staff to work in the State's health care facilities. The QHSDC's incentives involve working within the budget approved by its Board and meeting its ongoing financial obligations through attracting paying customers (ie students) for its courses.
Health care professionals in Qld, Health care professionals in other parts of Australasia and SE Asia, Users of health care services in Qld
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
Whilst the use of simulation to train health care professionals seems a sensible idea, it has not been evaluated rigorously and not systematically assessed in relation to the alternatives. Such
evaluations should be funded as an integral part of the work of centres such as the QHSDC.
As well as providing training and education, the QHSDC (and other Centres like it) should also be funded to evaluate:
The QHSDC originated as a rapid learning concept in 2000 and was regarded by the State Department of Health as a useful resources for the entire state. It was thus made into a state-wide
initiative. Although there are approximately 300 such centres in the world (7 in Oceania), the QHSDC claims to be the only State sponsored centre as others have grown organically around one or more
individuals who have been passionate about simulation.
The centre also has responsibilty for hosting the Centre for International Medical Graduates which trains overseas-trained doctors to pass their Qld medical registration and for the Pre Hospital Trauma Life Support program, a training package that aims to improve the outcomes of patients involved in trauma in rural and remote areas of Australasia.
|Implemented in this survey?|
The idea is not new to Australia or Queensland as there are approximately 300 medical skills simulation centres in the world. The main purpose of such facilities is to simulate many of the medical
and environmental conditions which arise in real patients and settings. As a result, practical training can be undertaken in an environment which is separate from but represents realistic
clinical situations where emergency and/or adverse events can occur. Training in such situations is particularly valuable because it removes the pressure of time and stress from the teaching
environment as well as reducing risks for patients.
Many such facilities have been set up as a result of the passion and drive of individuals who have convinced government and other funders to sponsor the development of the organisation over time. However, the QHSDC is the first in Australia to be wholly government sponsored and not to be affiliated with a particular hospital.
The Skills Development Centre has its own corporate governance structure with membership drawn from both the public and private sectors. Under the leadership of Acting State Executive Director of Innovation and Workforce Reform, Dr Mark Waters, it provides the strategic direction for the Centre and monitors the operations through three sub committees. The Centre has a small management team that brings the strategic vision into reality, including a chief executive officer, project manager, multi media manager and simulator coordinator.
The approach of the idea is described as:
It is not clear that there has been any opposition to the centre. The support for the centre from leading academics and clinicians indicates that it is regarded as necessary for the development of
clinical skills. However, no data are available about the total number of training courses offered or the number of attendees at such courses.
Although not explicitly stated, it is likely that providers and academics were the originators of the idea of the QHSDC which commenced as a rapid learning centre concept in 2000. However, the State government has been convinced to fund the capital equipment needed by the facility.
|Queensland Health||very supportive||strongly opposed|
|Lead clinicians||very supportive||strongly opposed|
|University of Qld||very supportive||strongly opposed|
No information available
|Queensland Health||very strong||none|
|Lead clinicians||very strong||none|
|University of Qld||very strong||none|
The main actors in the adoption process were the Qld government and the providers and academics involved in the original concept. However, the Board of the centre is involved in providing ongoing direction to the management group who are charged with meeting the objectives of the centre through providing training and raising funds via educational courses to maintain its functions into the future. Therefore, they must promote the facilities and training available to both public and private interest groups to ensure sufficient uptake of the educational training to meet the financial needs of the centre.
Monitoring: Although no specific mechanisms are listed, as one of the goals of the QHSDC is to produce innovative and research-based courses whose outcomes are properly evaluated, it may be
expected that monitoring the extent to which this occurs will from part of the activities of the centre.
Evaluation: A number of lead clinicians have been commissioned to develop the Centre's curriculum. Associated with this, the Centre is collaborating with the University of Qld to evaluate the effectiveness of the products it develops. In addition, visiting faculty assist in the development and evaluation of curriculum. The Centre also uses external instructional designers on an as required basis.
A limited amount of information is available regarding the ability of the QHSDC to meets its objectives. Whilst it may be able to provide educational services within its budget, as the demand
for such services is unknown, it may also fail and need further financial support from the Qld government. Alternatively, should the government choose not to provide additional support, the
Centre may be forced to seek support from private companies. Such companies are common supporters of these Centres around the world, including Australia. Their influence on the courses provided and
the equipment or devices used and/or recommended will depend on the relationship between the company and the Centre which may range from allowing the Centre to retain its independence to some
provision of company-related marketing material or a requirement to use and market its products or even prohibition of the use of competitors' equipment etc thus potentially errecting barriers
The scientific evidence regarding the effectiveness of simulation as a means of increasing the skills of health care professionals and/or the translation of these skills to practice is limited. No Australian evidence could be identified. Small-scale studies have shown that students, interns and residents can improve their skills in areas such as laparoscopic surgery and cardiac events (McGaghie and Issenberg, 2001). However, an assessment of the capability of virtual reality to train surgeons in laparoscopy was inconclusive (Johnson et al). Norman (2003) described computer based simulations as a "cottage industry championed by enthusiasts" and questioned the transferability of skills from the simulation laboratory to real patients, the use of single medium versus multi-media systems, the cost-effectiveness of simulations versus computer-based education and the lack of educational theory and best practice in relation to the use of simulators. The publication of this article was followed by a rebuttal of the main points raised by Norman although the authors agreed that there was a dearth of educational research in the health sciences (McGaghie, Issenberg and Petrusa, 2003).
Thus, the literature suggests that there is little evidence or agreement about the effectiveness of simulation as a means of improving the quality of care. No published evidenced was identifed regarding the effect of education using simulation on the costs, cost-effectiveness or equity of access to health care.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
As the model of training using simulation has not been well evaluated, it is not possible to rate the impact as being more than neutral or marginal. As there are many centres like the QHSDC in the world, it is to be expected that this may change in the near future. The First Oresund Symposium on Clinical Skills Training entitles "Why Skills Centres" will be held in Lund, Sweden in November 2004. Among its aims is "to discuss the impact of simulator training on clinical competence and the relation to quality of care and patient safety".
William C McGaghie and S Barry Issenberg (2001). Acquisition and maintenance of medical expertise from deliberate practice using simulation technology. Interface. http://www.gasnet.or/interface/12.1.3mcgaghie.html
Rob Johnston, Sunil Bhoyrul, Lawrence Way, Richard Satava, Kevin McGoven, Dexter Fletcher, Shawn Rangel, R Bowen Loftin (date not available). Assessing a virtual relaity surgical skills simulator. http://www.vmasc.odu.edu/vetl/html/surgery/mmvr4b.html
Geoffery Norman (2003). Simulation - saviour or satan? Editorial. Advances in Health Sciences Education. 8:1-3.
William C McGaghie, S Barry Issenberg, Emil R Petrusa (2003). Editorial: Simulation - saviour or satan? A rebuttal. Advances in Health Sciences Education. 8: 97-103.