Over the past decade in Canada, pediatric academic institutions have started simulation-based initiatives aimed at bridging the clinical-educational gap faced by healthcare providers and educators. With a variety of simulation-based modalities, such as task trainers, screen-based simulation, standardized patients, and whole-body mannequins, many centers have been successful at transforming the way medical education is delivered at the local level. However, these centers have evolved in relative isolation, developing their own educational curricula and research agendas. This has inevitably led to duplication of many of the activities inherent in the growth and development of each of these individual centers.
To optimize resources and to provide a venue for academic collaboration, a network of pediatric educators representing pediatric simulation programs from across Canada was conceived as the Canadian Pediatric Simulation Network (CPSN) at the inaugural meeting in Calgary, Canada, in 2007. Although the Calgary meeting was a networking opportunity for pediatric simulation educators, few concrete plans for advancing pediatric simulation in Canada were explored or planned. The network then held a second meeting in Vancouver, Canada, in September 2009. This meeting once again served as the ideal venue to connect simulation experts from across Canada, with the clear expectation to facilitate brainstorming and concrete plans for collaboration in the development of national initiatives for pediatric simulation. To ensure optimal use of time and effective collaboration, a premeeting survey was conducted before the network meeting to obtain an overview of the current state of pediatric simulation in Canada and to identify the top priorities for group discussion at the meeting. From this survey, the top priorities for national collaboration were identified, which were then incorporated into the network meeting agenda via focus group sessions.
MEETING STRUCTURE AND CONTENT
The meeting started with a plenary session from Dr. Amitai Ziv, from the Israel Center for Medical Simulation, who highlighted lessons learned from setting up a national simulation program. This lecture helped provide the attendees with a vision of how collaboration at the national level could lead to a wider and more profound impact. The rest of the morning was dedicated to discuss the current state of simulation programs in each of the pediatric academic institutions across the country. Leaders from each program presented their successes, challenges, and barriers to growth.
After lunch, three focus groups, led by expert facilitators, were held to brainstorm strategies for developing national programs in simulation curriculum design, crisis resource management, and instructor training. After reports from each of the focus group facilitators, a lecture outlining the Examining Pediatric Resuscitation Education using Simulation and Scripting (EXPRESS) International Pediatric Simulation Research Collaborative was given by Dr. Adam Cheng from BC Children's Hospital. This lecture provided meeting attendees with an overview of collaborative research opportunities on the national and international level. After this session, three more “special interest” focus groups were held, discussing simulation-based research, patient safety, and innovations in simulation. The final plenary was given by Dr. Vincent Grant from Alberta Children's Hospital, who described novel and practical ways of obtaining funding and support for simulation programs.
RESULTS OF FOCUS GROUPS
A total of 27 people attended the CPSN meeting (23 physicians, 3 nurses, and 1 respiratory therapist), representing 10 of the 11 identified pediatric simulation programs in Canada. As mentioned above, the six highest priority issues for national collaboration identified from the premeeting survey were curriculum development, instructor training, leadership and team training, research, patient safety, and innovation in simulation. Each issue was assigned to one focus group, consisting of 8 to 10 individuals who were asked to come up with one or two concrete suggestions in the specified content area to help move pediatric simulation forward in Canada in the next 3 to 5 years. After brainstorming and identifying key suggestions, each group was asked to discuss three things: (a) potential barriers preventing the implementation of their suggestion, (b) potential solutions to overcome these barriers, and (c) action items for the immediate future to help move the initiative forward.
Each focus group identified several possible suggestions to help advance the field of pediatric simulation in Canada. The most important suggestions from each category are outlined in Table 1, along with their projected barriers to implementation, possible solutions, and action items for the immediate future. The overwhelming theme from the focus groups was the need to standardize delivery of simulation-based education across Canada. This was reflected in the suggestion to develop the following: a simulation-based acute care curriculum for pediatric residency training programs, a national crisis resource management course for interprofessional learning, and a national simulation instructor training course. The other recurring theme was the need for more collaboration on a national level. Network members indicated that collaboration between simulation-based researchers could help build momentum for future projects. In addition, they identified the need to work together to advance the use of patient simulation as a patient safety tool in pediatric centers across Canada. Finally, the innovation focus group felt that the development of a website for simulation instructors and learners was essential in helping to coordinate simulation-based educational and research efforts across Canada.
At the end of the meeting, attendees were asked to complete a 12-item evaluation form seeking their feedback on various aspects of the meeting. Evaluation questions were rated on a 5-point Likert scale. In total, 20 evaluation forms (representing a response rate of 74%) were completed by the network meeting attendees [nurses (n = 3); respiratory therapists (n = 1); and physicians (n = 16)]. The results are presented in Figures 1 and 2. In the evaluation of the focus groups, attendees indicated that collaboration through the network would be helpful in advancing the simulation-based education, research, and patient safety initiatives at a national level. Attendees also felt strongly that the network meeting gave them ideas to help improve and promote simulation-based education at their own individual centers. Overall, network members thought that the meeting was an excellent networking opportunity, which would help to foster more collaboration on a national level. Attendees reported that it would be beneficial for the network to meet on an annual basis.
IMPLICATIONS FOR THE FUTURE
Existing academic networks have had to overcome many challenges and barriers on the road to success. Sustaining effective communication among geographically diverse members is a major barrier often overcome by bringing together network members via conference call, Internet webinars, or face-to-face meetings.1–9
Our national meetings have helped our network set priorities and goals for the future. We expect that many of these key issues are pertinent to most countries. However, the diverse and differing stage of simulation development around the world requires specific and individual needs assessments be done to address issues specific to each region or country. Furthermore, logistical issues facing different groups may necessitate alternative methods of networking, such as more Internet-based collaboration or regional meetings.
One of the significant limitations of the CPSN meeting was the lack of balanced interprofessional representation. Although the CPSN extends an open invitation and encourages all pediatric simulation educators to attend, the majority of attendees at this meeting were from a medical background. Several potential reasons that nonphysician representation was so low include inadequate funding from hospital to support allied health professional attendance at conferences, limited scope of involvement of nonphysicians in various simulation programs (particularly the new ones), paucity of nonphysician-relevant topics on the conference agenda, and poor advertising of the interprofessional nature of the meeting. The CPSN will continue to advocate for a more balanced attendance of its future meetings and hopes to increase attendance by all professional healthcare provider groups by (1) advocating that programs also send nonphysician simulation educators; (2) moving the meeting location around the country to allow for a fair share of travel expenses among simulation programs; and (3) considering approaching industry or government for formal sponsorship of the meeting. Another limitation of the meeting is the time constraint faced for discussion of several complex projects, especially on a national scale. Although some barriers to initial success were identified at this meeting, on-going discussion through the planning and implementation phases of these projects will be necessary to identify new barriers as they materialize.
Members of the CPSN have come together to identify several major projects to tackle over the next 3 to 5 years, which will help to advance the field of pediatric simulation in Canada. This network has been able to bring together leading innovators, educators, and researchers from across Canada to build momentum for national simulation-based initiatives. The CPSN hopes to learn from some of the barriers that existing networks have faced and circumvent the problems through anticipation, communication, and building a strong infrastructure. The CPSN also hopes to expand its membership and reach out to all groups providing pediatric simulation in Canada. Annual meetings of this network were strongly recommended by participants and will help to ensure that new and on-going projects are carried to completion and also to provide a forum for pediatric simulation leaders to share ideas and resources to help benefit local, provincial, and national programs. It is hoped that through its accomplishments, this network will set an example to the international simulation community by demonstrating how collaboration can help to advance simulation on a national level.
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