2018 Report on Education
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Team-based Learning

The goal of the team-based learning priority is to improve the performance of interprofessional teams through team assessment, self-directed team development, practice-based simulation, and the promotion of team innovators.

In supporting teams to reflect on their collaborative work, we facilitated 20 interprofessional teams to complete Sunnybrook’s in-house Team Assessment process. This process, based on Sunnybrook’s core competencies for interprofessional team collaboration, is the most extensive we know of in any healthcare organization in terms of the number and diversity of teams involved. Each team created a customized team-learning and development plan which will continue to enhance their work together over the coming year.

In addition, we launched an online team-based learning toolkit containing activities, tools, references and stories to help teams further their work together. The toolkit was accessed 540 times in the 2017/2018 academic year.

We integrated Sunnybrook’s core competencies for interprofessional team collaboration into the Simulation Centre’s facilitator guidebooks, scenarios and debriefi ng tools in order to enhance team-based learning.

We launched a series of emergency code simulations that incorporate a team-based approach and inclusion of Sunnybrook’s Core Competencies for Interprofessional Team Collaboration. In addition, we supported a TAHSN fellow whose work focused on using simulation and interprofessional collaboration to teach team members about advance care planning. By using this method of practicing the way we work in teams, we can optimize team performance and process.

In December 2017, we partnered with the University of Toronto, Centre for Interprofessional Education (CIPE) to offer a customized and organization specific version of the team development workshop entitled BOOST! Five Sunnybrook staff collaborated with the centre to facilitate the course — the first time it has been delivered in this format. Beyond our own walls, Sunnybrook provides leadership as part of a TAHSNp/CIPE-led initiative to create a TAHSN-wide Team Assessment tool. The pilot, which launched with six participating teams in March, will culminate in a Fall 2018 symposium to share system learning.

Sunnybrook’s Core Competencies for Interprofessional Team Collaboration

A diagram showing Interprofessional Collaboration, which intersects with Interprofessional Education and Interprofessional Practice. It is made up of six core competencies: Role Clarification, Shared Decision Making, Interprofessional Values and Ethics, Communication, Interprofessional Conflict Resolution, and Reflection. It relates to Education, Research, Leadership and Practice.

“Being a part of the education team was a valuable learning opportunity. Our work was thoughtful and included a substantial amount of refl ection to determine important themes that best matched what we want to produce here at Sunnybrook. While working with the education team and other patient and family partners I feel that together we developed important innovations on how teams can learn together to best serve the patient experience.” - Mathieu Wong, Patient & Family Partner

In the coming year, we will host an appreciation event for all teams who played a significant role in the success of Year One of this priority. Existing teams who completed a team assessment will be invited to present their progress, and the work that they have done on their team learning and development plans.

Based on popular demand and positive feedback, we will offer another BOOST! workshop and invite additional teams who completed the team assessment to participate.

We are committed to conducting 10 more team assessments to further our work and we will add a tool for patients to provide teams with feedback based on Sunnybrook’s Core Competencies for Interprofessional Team Collaboration.

We are undertaking an organizational assessment related to psychological safety in teams and the role of leaders in supporting psychological safety.

Lastly, we are creating an organization-specific definition of team-based learning.

Code Omega Obstetrics (OB) In-Situ Interprofessional Simulation

The goals for this initiative were to: recognize and appropriately manage Code Omega Obstetrics (OB) by improving adherence to the newly revised Sunnybrook Code Omega OB policy; and to enhance role clarity and decision making with the interprofessional team based on Sunnybrook’s Core Competencies for Interprofessional Team Collaboration.

Postpartum Hemorrhage (PPH) is a leading cause of morbidity and mortality worldwide. The DAN Women & Babies Program is an area of risk for PPH leading to massive blood loss and activation of Code Omega OB. It is crucial that staff be well trained in the management and adherence to the revised Code Omega OB policy at Sunnybrook in order to ensure optimal patient care and survival in this patient population.

This project is ongoing with identified outcomes of decreasing time to transfusion of the first unit of blood, improving adherence to the Code Omega OB policy and to improving competencies for interprofessional team collaboration.

This initiative is a first of its kind in the DAN Women & Babies Program to test an organizational protocol with interprofessional participation spanning over nine disciplines within the organization.

Interprofessional Code White In-Situ

We identified that not all Sunnybrook staff feel confident, or have appropriate skills in managing agitated and potentially aggressive patients, resulting in escalating staff injuries. In addition, role clarity, leadership, and team communication gaps were contributing factors to suboptimal team performance. In collaboration with Emergency Preparedness, an interprofessional simulation program was designed with a focus on de-escalation techniques. There were seven interprofessional education (Registered Practice Nurse, Registered Nurse, Physiotherapist, Occupational Therapist, and Social Worker) simulation sessions delivered to over 53 staff, incorporating the Sunnybrook interprofessional competencies. Simulation provides a safe immersive learning environment for participants to practice the skills, knowledge and attitudes required to de-escalate or manage situations involving agitated or potentially aggressive individuals. The outcome of the simulations resulted in early recognition of calling a code white; it also increased staff confidence and team support during incidences.

BOOST! (Building Optimal Outcomes from Successful Teamwork) is an innovative and interactive half-day, foundational team-based care workshop with an aim to improve interprofessional collaborative practice for clinical and project teams across organizations. Clinical teams in all areas of health care are striving to provide collaborative models of care that optimize patient outcomes and experiences. This is an opportunity to enhance the collaborative practice environment for all staff and students.

BOOST!

Collaboration with Sunnybrook and CIPE:
Dean Lising
Strategy Lead, IPE Curriculum & Collaborative Practice Lead
Centre for Interprofessional Education, University of Toronto, University Health Network, Toronto Western Hospital

Elizabeth McLaney
Director, Interprofessional Education, Sunnybrook Health Sciences Centre
Associate Director, Centre for Interprofessional Education, University of Toronto

Leanne Hughes
Professional Practice and Education Leader
Recreation Therapy
Sunnybrook Health Sciences Centre

Lina Gagliardi
Professional Leader, Social Work Sunnybrook Health Sciences Centre
Adjunct Lecturer, Factor-Inwentash Faculty of Social Work, University of Toronto

Leigh Andrews
Advanced Practice Nurse
High Risk Obstetrics & High Risk Birthing Unit
Aubrey & Marla DAN Women & Babies Program
Sunnybrook Health Sciences Centre

Karen Johansen
Advanced Practice Nurse
Sunnybrook Health Sciences Centre
Adjunct Lecturer, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto

35 attendees, 9 teams, 9 professions, including: Audiology, Physiotherapy, Occupational Therapy, Nursing, Clinical Nutrition, Activity Aide, Recreation Therapy, and Pharmacy

“Our unit-based Interprofessional Quality Council gathered to discuss the results of the assessment. An area identified for improvement was the competency of Reflection. Work began to provide our team with protected time to come together and reflect on difficult scenarios, to provide support, and [to] generate solutions. Additionally, it was identified that we needed to address the impact these challenges have on team members and how we work together and with patients. Quality council explored options, and identified the opportunity to hold a monthly reflection session. Team members were asked to share suggestions for topics of discussion during the reflection sessions through an email address and suggestion box on the unit. The first session was held and was well received by team members. An example of our first suggestion included a request that physiotherapy provide stretching and exercise education to the nursing team as it was Physiotherapy month. Additionally, a team member discussed a difficult case that she had worked on and through this the team members identified struggles and stresses that are shared among the health professions. The team was able to validate these concerns and support one another. What is unique about these reflection sessions is that they are team member driven with no individual facilitating. The first session was successful as it was well attended and positive feedback was received. Team members reported feeling a sense of camaraderie and community and the team looks forward to continuing to hold monthly sessions.” Reflections on the D2 experience

Sunnybrook Canadian Simulation Centre (SCSC) Re-Accreditation

The SCSC was granted re-accreditation from the Royal College of Physicians and Surgeons of Canada for a period of five years starting January 2017. Accredited simulation programs receive international recognition due to a rigorous peer review process that measures their ability to meet the highest standards in education, administration and ethics.

Simulation-based learning activities are designed and delivered according to simulation best practice, the latest educational research, and have a demonstrated impact on patient safety and quality care provided by health professionals.

Simulation activities span across all four priorities of Sunnybrook Education: Patient as Educator, Team-based Learning, Learner Experience & Culture, and Education Scholarship.

Interprofessional Postpartum Hemorrhage (PPH) In-Situ Simulation Education for Sunnybrook Women and Babies Program

The goal for this initiative was to increase the exposure of staff in the Women’s and Babies Program to the initial recognition and management of Postpartum Hemorrhage (PPH) patients. Education focusing on treatment of this rare event was identified as a gap at Sunnybrook as well as the International Postpartum Hemorrhage Collaborative Group and the Ontario Coroners Office. Simulation was identified by each of these groups as a quality care initiative to train interprofessional teams.

Four in-situ simulation exercises were completed for both the Maternal Newborn Unit and the High Risk Obstetrics Unit. The outcomes identified were unperceived gaps in practice and areas for process improvement, which were readily addressed through process change and debriefing. This was the first in-situ simulation for the Women and Babies Program addressing PPH as a quality care initiative to educate interprofessional teams and optimize safe, quality patient care.

This curriculum was expanded beyond initial PPH management to include training on the newly revised Sunnybrook Code Omega Obstetrics (OB) policy.

Obstetrics (OB) Outreach Simulation

In 2017, the SCSC began a community hospital outreach simulation program for the GTA Obstetrics (OBS) Network hospitals. The goal of this educational outreach curriculum is to improve the performance of interprofessional teams managing critically ill obstetric patients in a community hospital using in-situ simulation. This program was designed to meet several needs, specifically the increasing incidence of postpartum hemorrhage in North America. This topic is regularly discussed at conferences including a panel discussion at the International Anesthesia Research Society Meeting in April 2018. An Ontario Coroner’s report in 2016 issued a recommendation for all obstetrical and anaesthesia care providers to design, review and practice a massive transfusion protocol at their hospital. SCSC is sharing their expertise with the community through simulation education to help community hospitals reach the following goals in regards to improving obstetrical care: to improve their skills in interprofessional collaboration and communication with respect to management of obstetrical emergencies; and to analyze patient safety threats, both existing and latent, in their own clinical environment and formulate a plan to solve or mitigate these threats.

SCSC has offered this curriculum to two GTA OBS Network hospitals with the goal of eight by the end of 2018. This is a first of its kind for the SCSC, offering in-situ obstetrical emergency simulation education to our community.

When asked: “What I liked best about today’s simulation:”

  • “Running through situations with a team was beneficial”
  • “Immediate feedback [and a] chance to do [the] next situation with feedback”
  • “Hands-on techniques; group work.”
    • Corporate Nursing Orientation – New Staff, April 2018

Paediatric Emergencies In-Situ Interprofessional Simulation

Imagine a very ill child suddenly arriving in the emergency room of an adult hospital. Will the interprofessional staff be ready and able to manage this extremely stressful, rare occurrence? At Sunnybrook, the answer is “YES.” The Sunnybrook Emergency Department, in collaboration with the SCSC created a simulation curriculum to improve the interdisciplinary team’s comfort level, knowledge and skill set when managing paediatric emergencies. This type of staff education is critical as Sunnybrook sees a very low volume of paediatric patients. The interprofessional paediatric simulation curriculum was the first of its kind in the Sunnybrook Emergency Department and has been recognized by the Canadian Association of Emergency Physicians 2018 annual conference. This curriculum was made possible by the generous donation of a paediatric simulator to Sunnybrook hospital by Donald and Nita Reed in 2017.

Code Orange In-Situ Interprofessional Simulation

Unfortunately Code Orange (mass casualty) is a very real threat for which Sunnybrook, Canada’s largest regional trauma hospital, must be prepared. Through the leadership of the Sunnybrook Emergency Preparedness Department, the SCSC is committed to helping achieve this goal with the use of simulation education. In October 2017, Sunnybrook conducted its first in-situ, live actor, mass casualty simulation. Sunnybrook, along with external partners, worked together to test the existing code orange policy. The results of this informed a larger organizational and multiple partner table-top exercise in early 2018 that was led by Emergency Preparedness to further inform the development of a new Code Orange policy. Simulated and table top exercises will continue to take place throughout 2018. The SCSC continues to support the Emergency Preparedness team to ensure that Sunnybrook staff are well equipped and prepared to manage Code Orange.

Advance Care Planning (ACP)

Advance Care Planning (ACP) Week (2018) at Sunnybrook was exciting, educational, and thought-provoking. One aspect of the week featured a game show-style activity where a simulation entitled “ACP Star,”invited contestants to compete in simulated ACP conversations with simulated patients and family members. Judges then assessed their performance during their discussion and interactions with the simulated participants. The audience was given an opportunity to ask questions and vote on the winner.

Values Matter Selfies

Another engaging element of the week involved a: “Values Matter Challenge.” The premise of this activity was to challenge Sunnybrook staff to think about their values and identify their most important one. They were provided the opportunity to submit in a selfie to sunnynet.ca/valuesmatter. To promote this initiative, the SCSC created a video engaging a diverse group of interprofessionals identifying their most important value. ACP conversations involve exploring a person’s values, beliefs and wishes related to their future healthcare and identifying their Substitute Decision Maker (SDM). Improving communication skills in ACP conversations is beneficial to patients, families, staff and the entire health care system. These initiatives educate staff and continue to support the Sunnybrook Corporate Quality Living and Dying strategic priority of improving the overall patient experience.

Cardiac and Lung Ultrasonography

Anesthesiologists have been leaders in the use of ultrasound for regional anesthetic techniques and much more. The use of ultrasound for perioperative care is now being recognized. In order to enable Sunnybrook’s anesthesia staff to acquire the skills required to expand their role of ultrasound in the perioperative period, the department of anesthesia, in collaboration with the SCSC has developed a fully accredited ultrasonography course to address this need. The full-day class includes training on different industry-standard portable ultrasound machines using live models, interpretation training, and training using our advanced CAE 3-D ultrasound simulator. This simulator provides trainees with multiple cases varying in difficulty, as well as a free-scan mode that allows them to compare 3-D structure models on screen with realistic ultrasound images.

In addition to anesthesia, the simulation programs train Sunnybrook residents and staff from the departments of surgery, emergency medicine, critical care, and internal medicine. The simulator has been extremely helpful in training members of the Sunnybrook trauma team on how to perform the extended-FAST trauma scan, and for training emergency staff physicians on how to perform a focused echocardiogram.

“Fantastic hands-on approach that should be emphasized more during our clerkship. It would be very helpful to have that training more than once.”

“Great day! Wish we had more simulation opportunities and hands-on learning in clerkship!”

Anesthesia Clerks, May 2018