nexus news | October 2018
NEWS, VIEWS AND INFORMATION
FOR APLS MEMBERS
Jeremy Raftos, Order of Australia Medallist
PAC Conference program announced
Dates for your diary - 2019 courses launched
APLS in a day: introducing PLS
From the CDC: course content updates
Teaching tips from course coaches
APLS in Papua New Guinea
From the CEO
Welcome fellow APLSers to the October 2018 edition of APLS Nexus!
A few months back, members of the APLS Board, APLS office staff, and some representatives from our sub-committees met for a day to develop our APLS Strategic Plan for the next few years.
I have been involved with our organisation for quite a long time and had always thought of APLS as the leading provider in the field of paediatric resuscitation education.
Our Strategy Day challenged my view. I now recognise that we are more than just an education provider. Over the last 20 years, we have had over 12,000 health care providers do one of our courses and we have over 1500 instructors currently teaching APLS courses.
When I reflect upon the way my day-to-day practice changed after doing my APLS course in 1997, I realise that our organisation has influenced and continues to positively influence the practice of thousands of Australian healthcare practitioners every year.
It’s not that much of a jump to think that every day our APLS Community of Practice makes a positive contribution to the health of Australian kids. This slight adjustment to our frame will, I hope, be seen as a positive move as we implement some updates and new offerings across the next few years.
As a part of this, we have plans to better ensure that we provide opportunities for all of our past course participants, as well as our instructors, to keep up to date with the latest changes in our field of practice. This will include some “micro-education” events by members of our APLS community that will be available for viewing on your mobile devices (during a quiet moment) and a shorter format APLS Refresher course. Stay tuned for these.
You can read more detail about the APLS Strategic Plan in this column from CEO Phillip Davies.
I mentioned in our last update that we had made an application for full membership of the Australian Resuscitation Council. I am pleased to report that our application, supported by the Australasian College of Emergency Medicine and the Perinatal Society of Australia & New Zealand, was successful and APLS is now a full voting member of the ARC.
As a part of our responsibilities as a member organisation, we contribute to and feedback upon all new and revised ARC guidelines. We are currently developing a mechanism to allow us to send draft guidelines out to our entire membership and assimilate feedback from members to pass on to ARC. We appreciate your input into these national guidelines and see this as a very positive step allowing us to influence paediatric resuscitative practices around the country.
As another part of our strategic plan, we will be making even closer links with the PREDICT paediatric emergency research network. The opportunities for better linking research, education and embedding new knowledge into practice should benefit all. As a first step, PREDICT now have a standing member on our PAC conference organising committee and a dedicated PREDICT session at PAC conferences.
We have continued to update our data systems and you will have noticed our steady roll out of post-course feedback moving to an electronic format.
The APLS Paediatric Acute Care Conference is coming up soon in October. I’m very excited about the topics and the speakers we have this year. We have listened to the feedback from the 2017 conference and I hope that you will enjoy the improvements.
On a final note, I have to give a “shout out” to Dr Jeremy Raftos who was awarded a Medal of the Order of Australia (OAM) in the recent Queen’s Birthday Honours. Jeremy was one of the founding fathers of Paediatric Emergency Medicine in Australia, is a Past President of APLS, and is an all-round legend! I have always looked up to him both as a practitioner and as a person and I cannot think of a more deserving person to receive an Australian Honour. On behalf of the APLS Community, well done Jeremy!
Most APLS instructors will have met Dr Jeremy Raftos at courses, at PAC, through APLS committees or through other professional forums.
The next time you see him, be sure to bend a knee as we're delighted to congratulate Jeremy on his Order of Australia Medal for service to medicine and paediatrics.
Here's Jeremy's moving talk on self-care for clinicians, one of the highlights of PAC 2017.
Jeremy retired from his paediatric emergency position in February last year after over 30 years’ service to the Women’s and Children’s Hospital in Adelaide.
He was the founding director of the paediatric emergency department and remained its medical head for 26 years, a record unlikely to be ever broken.
He was also closely involved in the establishment of paediatric emergency medicine as a specialty in Australia.
Jeremy's long association with APLS began with the very first Australian provider and instructor courses in 1996 and, and he became one of the key players in the foundation of APLS Australia.
He has instructed on countless one day, three day and GIC courses since and held a number of important roles within APLS including President, International Committee chair and serving on the APLS board.
In recent years with the support of the international instructor group and APLS Australia he has established APLS in Sri Lanka and the Maldives with both programs having the potential to save many lives and improve care. The Sri Lankan College of Physicians awarded him an honorary fellowship in 2015 for his APLS work.
Later in his career he developed interests in the fields of paediatric palliative care and medical hypnosis. He continues to have a role as a teacher at the University of Adelaide Medical School where he works as a tutor.
In recognition of his work Jeremy received two special awards this year: a Distinguished Service Award from the Women's and Children's Hospital, and the aforementioned OAM for service to medicine and paediatrics. Ironically, given that he is a staunch republican, this was on the Queen’s Birthday honours list!
All of us at APLS wish Jeremy a long and happy retirement.
Just one month until our biggest weekend of the year – the 2018 Paediatric Acute Care Conference – and a full program is now available.
Here's those sessions and speakers in full:
PAC 2018 will be themed around these seven topics:
All this plus a dedicated day for APLS instructors, fun social events, an afternoon of small group workshops and lots more.
It's not too late to join us in Hobart, and we'd love to see you there.
We're excited to announce a packed course calendar for 2019, with 66 new APLS courses now available for registration.
You can browse courses near you and register today via our course calendar.
For instructors, head to Choose your Courses to get your nominations in early.
Are you curious about APLS but not ready for the full three day course?
Would you like to try the structured approach to see if our courses suit your learning style?
Then our one day PLS course is for you.
Reinvigorated this year with updated content and a brand new e-learning package, our one day Paediatric Life Support course runs in tandem alongside the full Advanced Paediatric Life Support course.
On PLS, you'll be introduced to the structured ABCDE approach in friendly small group sessions. PLS focuses on the first ten minutes of emergency paediatric care: basic life support, airway and breathing, cardiac rhythm recognition and defibrillation, and the recognition and management of serious injuries and serious illness.
Like APLS, it's a dynamic, hands-on course taught by full APLS instructors and APLS graduates. The new pre-course online learning package will get you familiar with key concepts. Candidates receive the same comprehensive course manual used on the three day course. The face-to-face course is based around scenarios, workshops and interactive sessions to build your confidence.
It's perfect for any nurse, doctor or paramedic new to APLS or to springboard towards the three day APLS course, which goes into more depth on a wider range of paediatric emergencies.
And best of all, if you go on to take a three day course afterwards, PLS is free. All PLS candidates are eligible for a $250 discount on their future APLS course fees, for use before booking.
You can watch PLS course director Justine Dawson introduce the new online learning package in the video above. For more information or to claim a discount voucher, contact your local PLS co-ordinator or email@example.com.
The APLS board recently held a strategic planning day. It was an opportunity to really think about what the purpose of APLS is, what our assets are and how best to fulfil our goals.
Through this process, it was clear that the most precious assets are our instructors. The strength of each course comes through the unique set of skills and experiences that each instructor brings to the course they teach, their dedication to providing the best teaching possible, and their willingness to share with and learn from the other course participants.
The CDC acknowledges the priceless contribution that you, our instructors, make to APLS and thanks you.
The CDC met recently so here is an update on what’s happening and what’s being planned:
- Airways teaching updates - The updates to the airways skills teaching and replacement of the surgical airways skills station are in the process of being trialled.
- The Airways Skills session now includes candidate practice of LMA insertion.
- The surgical airways station has been replaced with a workshop, using the case of a sick infant in need of advanced airway management, to discuss in detail a structured approach to airway management, stressing the need to anticipate and plan for difficulties.
- These changes were made in response to feedback given by a large number of instructors who were concerned that the surgical airways station places too much emphasis on skills which were very unlikely to ever be needed and, if attempted, were very likely to fail. There was concern also that there was not enough teaching of a structured approach to advanced airway management, a skill that it much more likely to be required.
- Like any big change we are anticipating teething difficulties. Feedback from the next few courses using the new material will help the CDC refine the information given to assist instructors to run the workshop. We hope to introduce it to all courses before the end of the year. Thanks go to the working group of Tom Grattan Smith, Chris Holmes, Elliot Long and Dave Barker for making this possible in a relatively short time. Great work.
- We are planning a session at PAC Instructors Day to present the feedback so far and explore what to keep and what to change in our airway teaching. Therefore, we're inviting all instructors who have had some experience of the trial to give us their feedback and suggestions prior to PAC so it can be included in the discussions. Please send your thoughts to firstname.lastname@example.org.
- Online learning review - in addition to responding to feedback from course directors’ reports each module will be reviewed by members of the CDC. The aim will be to detect and correct discrepancies between the various components of the course and to suggest ways in which time taken to do the online learning can be shortened.
- Neonatal online module - this has long been on the “wish list” and is currently a work in process. Existing resources will be explored rather than immediately investing resources into “reinventing the wheel”. We will keep you posted on progress.
- Radiology workshop review - This will be the next “big” project, no doubt with many opinions about what shape it should take. Consultation with the instructor body to assess what we believe the aim of the workshop is, what the aim should be, and how best to achieve this, will be the initial step and will begin later in the year.
Thanks to the CDC team who manage to fit a lot of work around their busy schedules.
on behalf of the APLS Course Development Committee
Approximately a quarter of APLS courses since January have included a course coach. In collaboration with course directors, coaches have been supporting faculty with both an ‘opt in’ (only when requested) and ‘opt out’ (thanks but no thanks) approach.
Feedback from faculty who have been on courses with a coach has been positive, with the major issue being limited time for coaches to actually provide feedback.
The major area of focus requested by faculty has been around learning conversation-style feedback.
Other areas include:
Increasing interaction amongst members of the groups in discussions and workshops.
Variability in skills teaching approaches continues to promote debate about the value of the four stage approach.
Amy Seymour-Walsh, a paramedic from Flinders University, completed her PhD on this very topic and will be presenting at the PAC Conference Instructor Day on Thursday 25th October.
Here are some general coaching tips for maximising post-scenario reflection and learning from candidates.
Instructor Mindset on Day 1:
Be mindful of the cognitive load on candidates trying to understand faculty ‘expectations’ of them as well as becoming comfortable in front of their colour group. In reality, there is a sense that both peers and faculty are assessors, despite the supportive and friendly atmosphere. (Of course, faculty have their own cognitive load!)
Scenarios (especially for Cardiac scenarios on Day 1)
Set up the expectation at the beginning that at the end of the scenario there will be a ‘learning conversation’ for the whole group – to discuss what has been learnt from the given scenario in relation to application in the group’s clinical context(s). They participate in 24 scenarios over the three days – the main outcome should be that ABCD will become a brainstem ‘safe’ approach. However, allowing the group to share their knowledge allows for supporting the diversity of learners.
As each scenario in the course has a different clinical situation, the learning conversation allows for discussion/thinking about differential diagnosis and ongoing management options.
APLS scenarios ask the candidate to take ‘sole’ responsibility (which is different to many workplace scenarios) – candidates are trying to work out what you as the instructor (‘assessor’) is expecting of them…..aside from remembering the defibrillation ‘drill’, there is a cognitive load working out the expectations of how ‘APLS run scenarios’ and feeling safe amongst the peers in their colour group.
Modify context of scenario for candidate – ‘remind me where you work’ – assists in creating a more realistic setting and nomination of roles for 1-2 ‘capable but without initiative’ assistants.
After you have given the candidate the scenario, ask them to present the situation to their assistants (and effectively the rest of the group), and direct the support they want from their assistants. Candidates often allocate an ‘airway’ and ‘circulation’ role. This can minimise time at the whiteboard as one of the assistants can support with checking the calculations, using the Monash Medication book.
Consider concluding the scenario with a handover to a team member who has come to help (this can be another member of their group) – this way you and the group already know what the candidate has been thinking about the case and what they want done next.
Consider having your co-facilitator lead the learning conversation – this reduces the cognitive load of the facilitator running the scenario – but doesn’t stop them contributing if the candidate or group hasn’t raised an issue that is important for the key learning objectives of the case.
Some suggested ‘conversation starters’ – anticipating that the candidate is ‘activated’ and may need to release thoughts as part of the reaction phase following leading a scenario.
From my perspective you managed that case safely by using a systematic approach. How was it for you? – don’t forget to PAUSE……..
OK, so what would you like to talk about related to managing cases like that? – again try to PAUSE…………..
Allow time for politeness and space for thinking – a candidate once said to me – ‘oh no they are going to ask me what I think and there is so much going on for me that the moment they ask me, my mind goes blank!'
The verbal preparation before the scenario begins sets the scene to ask the candidate to reflect on their management of a real case similar to the scenario.
When it comes to raising points relevant to the key learning objectives or what happened in the scenario – try to avoid a dialogue between the facilitator and one candidate.
It's good to reflect on this and consider where we sit within the group and how we facilitate to encourage the pattern on the right. It takes some courage to pose a question and then sit back and let the group continue with the discussion.
To facilitate this, avoid the use of ‘guess what I’m thinking’ questions – appreciating that this is easier said than done!
The conversation can be led by stating an observation/fact and being genuinely curious about what the candidate/s may be thinking or how it may be relevant for their practice.
E.g. this case could have had several underlying causes. Can we discuss differential diagnoses and the implications for management?
Safety is a key concern when using the defibrillator. Can we explore what strategies are used by all of you to keep the team safe?
Given the recent modifications to recommended fluid volumes, can we discuss what criteria are used to assess when more volume may be necessary?
When the saturations started dropping, you said “…………….”. What were you thinking at that time? And then to the group.....What were others considering?
Candidates will often respond directly to the facilitator asking the question – at this point, divert your eye contact / use body language to invite the group to confirm the comments made and contribute themselves. Take care with strongly affirming ‘yes’ – you can set up a ‘quiz’ type dialogue, where the lead facilitator is the one with all the correct answers. If you can avoid commenting, you are displaying that you anticipate the knowledge is available within the group. This also gives you opportunity to draw on the clinical experience of some and can lead to the group asking questions that are relevant to their practice.
Finish by summarising the key points for clinical application, based not only on the case, but the questions and discussion that followed.
Finally, I hope to see you in Hobart at the PAC 2018 Instructor Day.
Following the presentation by Amy Seymour-Walsh, Mike Shepherd is going to lead us in an interactive session aimed at supporting facilitators’ approach to scenarios by getting them to think about
how the adult learner works,
how to genuinely be curious and
how to approach scenarios in a safe way to develop learning conversations.
Finally, you can read the latest publication by ALSG lead educators Mike Davis and Kate Denning:
Listening through the learning conversation: a thought provoking intervention
This December will see the first ever APLS course in Papua New Guinea.
This project has been championed by local PNG paediatrician and recent APLS instructor Dr Kone Sobe and Dr Zafar Smith (pictured above), an emergency physician based in Australia.
Dr Sobe and Dr Smith met for the first time in May this year to start the preparations. There was overwhelming interest and support from the wider APLS community with over 30 applications from people wanting to help and instruct on the course.
An experienced team of five instructors from anaesthetic, emergency, intensive care and paediatric backgrounds – who have all travelled to Papua New Guinea in the past – will venture to Port Moresby to facilitate a course for 12 candidates that include local PNG emergency doctors, paediatric staff, anaesthetic staff and nurses.
This is the first time that such a course has been carried out in Port Moresby, with staff from multiple disciplines coming together to learn and share their experiences. This is also a unique partnership between APLS and YWAM Medical Ships who will be supplying for free the venue and accommodation for the course.
Instructors will sleep on board the YWAM PNG medical ship (above) which will be docked in the Port Moresby harbour, and local PNG candidates will come on board each day to attend the course which will be carried out in the ship's meeting facilities.
Simulation equipment including mannequins and scenario materials will be donated to the PNG medical staff to use for ongoing training and future APLS courses. This will hopefully be the first of many APLS courses to be run in PNG over the coming years.
For more information on APLS International, visit apls.org.au/international
Dr Zafar Smith
on behalf of APLS International
The APLS Board and a few of the members of our clinical governance committees attended a board Strategy Day in May 2018. We have produced a strategic plan for APLS for 2018-2023 arising from our discussions.
At the Strategy Day, the Board reaffirmed our overarching purpose of improving paediatric clinical outcomes in critical care situations.
We also assessed as part of our discussion what our core approach is, what is our vision for the next three years and what is our aspirational goal by 2021. Here are some of our conclusions.
Our core approach:
APLS is at the heart of a community of practice that works to train and influence for good outcomes across the whole paediatric care experience. Our core approach sets out the key ideas underpinning how we will deliver on our purpose.
Our vision for 2021 is:
By 2021 APLS will be recognised as being central to raising the standard of care provided to acutely ill children in Australia.
Our aspiration is that by 2021:
Every child in Australia with a serious or critical illness or injury will experience the best possible care, positively influenced by the APLS community.
Our four main strategic pillars of APLS arising out of that document and those fundamental notions are as follows:
- To influence, educate and train at key leverage points in the health ecosystem to ensure maximum impact
- Content and expertise kept current and quality maintained
- Continue to engage our instructor community
- Better engage our course graduate community
Once again to confirm such a strategy involves APLS continuing to run PLS and APLS courses around Australia in capital, regional and rural settings. We will also continue to run GIC and international courses. As part of this strategy we will also continue to run our new Educational Skills Development Course for instructors.
There is, of course, considerable work to be undertaken in respect of each of the strategic pillars. Some of the initiatives we already have in progress fit comfortably within those strategic pillars. However, the strategic pillars will drive new initiatives to be undertaken by APLS over the next three years.
We will be discussing this strategic plan with our members at PAC 2018. So, just a reminder that our conference in Hobart is only four weeks away, from 24 October to 26 October inclusive. We would love to see you there to be part of the discussion of our strategic plan and the future possibilities for APLS in Australia.
See you in Hobart.