nexus news | February 2018
NEWS, VIEWS AND INFORMATION
FOR APLS MEMBERS
2018 course calendar launched
My APLS: add your bio
Introducing course coaches
Surgical airway: teaching update
Algorithm & app updates
PAC 2017 in summary, 2018 dates
APLS in Myanmar
A new online hub for APLS International
From the CEO
Welcome fellow APLSers to the first edition of APLS Nexus for 2018!
We recently held our first APLS Board meeting for the year at the Melbourne office and it was great to hear that some of the feedback and ideas discussed at last year’s APLS instructor / director sessions prior to the PAC Conference are already being put into action.
Instructors will notice an extra person on the faculty for courses now. This faculty member will be dedicated to providing constructive feedback (a ‘learning conversation’) on our facilitation techniques. I look forward to taking advantage of this offering.
The Course Development Committee is also finalising the format of our updated Approach to the Difficult Emergent Airway skills session which was flagged as an issue at the Instructor Day and then reviewed so eloquently in Julia Haire’s wonderful presentation at PAC.
The PAC Conference also gave us an opportunity to reconnect with members from ALSG in the UK, the original developers of APLS. I have had recent correspondence with Sue Wieteska, the CEO of ALSG UK, and she was keen to have our organisations working more closely together to prevent unnecessary duplication of effort in future course initiatives. To ensure better UK-Australian relationships, I did ask her not to mention the cricket!
In March, I will be attending the Australian Resuscitation Council meeting in Melbourne. The ARC along with the NZ Resuscitation Council (ANZCOR), the American Heart Association (AHA), the European Resuscitation Council (ERC), the Heart and Stroke Foundation of Canada (HSFC), the Resuscitation Councils of Southern Africa (RCSA), the Inter-American Heart Foundation (IAHF) and the Resuscitation Council of Asia (RCA) make up the International Liaison Committee on Resuscitation (ILCOR) which is responsible for developing the Resuscitation Guidelines that guide all of our practice and teaching.
I have been attending ARC meetings over the last year as a “co-opted” paediatric representative. At next month’s meeting our application to have APLS Australia acknowledged as a full member of the Australian Resuscitation Council will be voted upon. I will keep you posted on the outcome (fingers crossed).
Our next APLS Board meeting in May will be dedicated to developing our organisation’s strategic plan for the next few years. We have a great organisation, a great culture, and a great membership (you!). It is important that, as an ongoing imperative, we continue to strive to improve our educational products, our educational techniques, and most importantly, support our membership.
Here’s to a great 2018!
A new year and a new course calendar, with 63 APLS and 43 PLS courses (and counting!) taking place across Australia this year.
To browse and book a place on a course near you, use the interactive map above or visit our course calendar.
For instructors, get your nominations in early via Choose your Courses.
The next time you log into your My APLS profile, you'll see a new field called ‘Bio and teaching interests’.
This is to help directors in allocating teaching sessions towards your interests and specialisms. It's also a chance to find out more about you, your career and history with APLS.
You can also add a photo to your profile. Both are totally optional, but pictures of cute dogs may help secure a place on the ever-popular Broome course...
It has been recognised that the Surgical Airway skills station needs updating so the APLS Course Development Committee spent time over the year investigating what represents current practice and evidence for this.
There is an emerging trend towards adopting a step-wise approach to a failed airway, with recognition that the need to perform a surgical airway in a child is a very rare event, and that the use of other supraglottic airway devices such as LMAs is of greater importance.
A discussion was held at the instructor session of the PAC meeting and it was decided that a scenario-type session involving a structured approach to a failed intubation or difficult airway, will be developed, rather than concentrating only on the skill of performing a surgical airway. Team work will be involved. This will be based on the RCH Emergency Airway guidelines
Surgical airways and CICO scenarios will be discussed and reference made to YouTube videos produced by an airways expert from WA, giving details instructions, but the skills won’t be practiced by the candidates.
Insertion of a supraglottic airway device will be demonstrated and practiced during the airways teaching on day one of the face-to-face programme.
This is likely to require some rearrangement of the programme.
The CDC will work on this as a priority, however it will take some time. In the interim the surgical airway station will continue as is, with the change to using the Rapid O2 device for insufflation rather than a three-way tap.
Chair, APLS Course Development Committee
The rollout of course coaches – a senior GIC instructor joining each faculty to support instructors in their teaching – has begun.
It is not yet happening on every course but there has been positive feedback from faculty when a course coach has attended.
Clinicians usually teach within a hierarchy system (senior to junior) with groups of learners who have similar learning needs.
This is different from the peer-peer model in ALSG courses where the approach is as a 'guide on the side' rather than a 'sage on the stage' – and therefore there are some differences in teaching approaches and behaviours.
The following are guidelines for how the role can support APLS faculty. However, the IDC is continuing to be responsive to feedback during the rollout period so, if you have any comments or suggestions, please pass them on via the office or email Jane.Stanford@apls.org.au
APLS Provider Course Coaching Guidelines
- Director and Coach to discuss role and practical aspects prior to course commencing
- Email to faculty notifying that coach will be on the course
Introduction at 1st faculty meeting:
- Role is for support and development
- Aim is for a culture of faculty supporting each other. The focus is for developing skills in teaching behaviours that focus on learner's needs within multidisciplinary and varied experienced groups
- If notes are taken they are as memory prompts for specific feedback to those involved & not part of course report
- Faculty are invited to request feedback from their sessions. Ideally faculty nominate areas of their teaching that they would like to receive feedback. This helps with the coach watching for specific behaviours during a session and provides a guide for post session conversations to be on the area of concern relevant for the instructor
During the course:
- Coach is responsive to needs of the faculty. This may include facilitating sessions or providing mini tutorials as requested
After the course:
- Faculty will be given the opportunity to give feedback about having a course coach on APLS courses
Suggested resources (in addition to those available on the APLS website under 'Course Materials and Resources’) for peer review of teaching skills and behaviours are:
Pocket Guide to teaching for Clinical Instructors – 3rd edition
The London Handbook of Debriefing pg 15
Cheng, A., Grant, V., Huffman, J., Burgess, G., , D., Robinson, T., & , W. (2017). Coaching the : Peer Coaching to Improve Debriefing Quality in Simulation Programs. Simul . doi:10.1097/sih.0000000000000232
Rudolph, J. W., Robert, S., , R., Dufresne, R. L., & , D. B. (2007). Debriefing with Good Judgment: Combining Rigorous Feedback with Genuine Inquiry. Anesthesiology Clinics, 25, 361-376. doi:10.1016/j.anclin.2007.03.007
Rudolph, J. W. (2014). Establishing a safe container for learning in simulation: the role of the briefing. Simulation in Healthcare, 9(6), 339.
After a new year's update, the latest APLS algorithms and checklists can now be found in the free APLS app.
The app contains 17 quick reference algorithms, coming course dates, PAC conference videos and more.
This set of algorithms were revised in late 2017 for consistency with the 6th edition manual and current APLS teaching. They contain a number of important changes, and some all-new protocols and checklists have also been developed.
These updated algorithms will continue to be rolled out into course materials and online learning from the new year onwards.
The app is free, and a handy resource for candidates with 23,000 users and counting. So please keep spreading the word on your courses.
If you already have the app, be sure to update it. If not, you can download it here:
The 2017 Paediatric Acute Care (PAC) Conference was held in October at the Marriott Hotel & Spa, Surfers Paradise. This was a particularly special occasion as 2017 marked 20 years of APLS in Australia.
In one sense this conference was part celebration and part reunion. Many of the "Twelve Apostles" – the dozen candidates on the first Australian APLS & GIC courses, who were then tasked with spreading the APLS gospel – attended PAC 2017. They were joined by our guests of honour from the Advanced Life Support Group (ALSG) in the UK, Sue Wieteska, Kate Denning and Chris Vallis.
In another sense the conference showed what keeps APLS vibrant, with 60 of the 160 delegates coming from outside the APLS family of instructors, and more than half of these from nursing and paramedic craft groups.
However as always the focus of the conference is to provide high quality, cutting edge insights into paediatric acute care. Topics discussed at the Directors’ and Instructor’s Day included the introduction of an “APLS coach” on courses to facilitate instructor development, the role of assessment for learning, updates to the 6th edition manual, and the changing emphasis on spinal immobilisation and airway rescue skills. You can read more about some of these elsewhere in this newsletter.
Over the next two days invited speakers took to the stage with a fascinating range of expertise and viewpoints on show. The conference theme, 'PAC to the Future,’ was introduced by APLS Presidents past and present while representatives from ALSG spoke on the global history and the capacity of APLS to bring about change in acute paediatric healthcare, as well as what the next 20 years might hold.
Other speakers covered areas including paediatric acute care research, airway rescue, the challenges of paediatric care in resource poor international settings, communication gradients, a review of recent key papers, the use of practical hypnotism in emergency care, a highly entertaining debate on spinal immobilisation, and a moving and inspiring session on self-care for clinicians.
As always, sessions from PAC 2017 will be available for catch-up viewing via the APLS Vimeo channel with free and open access for all.
Two sessions are available now:
Julia Haire's excellent summary of advances in airway rescue techniques, and Robin Choong on caring for yourself as a clinician or as he puts it, 'How to be badass every day'. More will follow throughout the year, so keep an eye on the channel.
PAC 2018 will take place on 25–27 October in Hobart, and the organising committee has already started working on delivering another high quality meeting.
The APLS Project in Myanmar is in an exciting phase of consolidation as we enter 2018.
A team of eight Australian APLS faculty are in the last stages of preparation to return in late February for a fourth visit to Myanmar.
We will conduct two three-day APLS Provider courses with a candidate mix of Postgraduate Trainees in Emergency Medicine, Paediatrics and Paediatric Surgery along with a small number of Specialist Anaesthetists. Our team will be teaching alongside 12 Myanmar Instructor Candidates.
In June last year, during our third visit to Myanmar, our team successfully conducted the first APLS Instructor Course for 12 Myanmar candidates, graduates of our previous visits in 2013 and 2015.
The Instructor Course ran very well resulting in 12 Myanmar Instructor Candidates who were both excited (and a little nervous) to then immediately teach the APLS International Provider course with our team in support. The course was delivered to 25 third year Masters of Emergency Medicine students in the last six months of their three year Masters course, and who represented the first ever cohort of Masters of Emergency Medicine doctors in Myanmar.
As with previous visits we were very generously hosted by all our Myanmar colleagues and friends. In particular we thank Dr Aye Thiri Naing for her tireless efforts both to ensuring our visit went smoothly and for her unwavering commitment to embedding APLS teaching into Myanmar in partnership with Rector Professor Zaw Wai Soe.
We were able to visit both Yangon General Hospital and the Yangon Children’s Hospital thanks to Dr Rose Skalicky and Dr Aye Thiri Naing. It was fantastic to see significant improvements in both the physical spaces and equipment available for emergency care at those two hospitals – especially when compared to our first visit in 2013.
The key objectives of the upcoming visit is to have our Myanmar Instructor Candidates successfully complete their second APLS Provider course as Instructors and likely gain full Instructor status. Additionally, Dr Aye Thiri Naing will take on a Director Candidate’s role for the second course with support from myself and the entire Australian faculty.
We have also been very fortunate to identified a locally-based course coordinator, Aye Kalyar. Aye has acted in that role on two previous visits and increasingly taken on more and more of the pre course preparation. We will be supporting Aye to coordinate both these courses with the aim of having her fully capable of being able to coordinate future courses independently.
Aye has been very fortunate to be trained and supported by the wonderful Michelle McCarthy over the last few courses and I would like to thank Michelle on behalf of everyone involved in the Myanmar APLS Program.
I would also like to extend our sincere thanks to the APLS International supporters within APLS Australia HQ – in particular Phillip Davies, Sharlene Kinnaird, Sally Guthrie and Dr Susan Phin as a very supportive Chair of the APLS International Commnittee
Lastly, I want to thank all the many APLS members who have contributed their time, enthusiasm, expertise and money – and many on multiple occasions – to this rewarding program as it moves into this consolidation phase.
Our new website for all things APLS International is now live.
Whether you're a current international instructor, interested in joining a program or just curious about our outreach work, visit apls.org.au/international.
You can find advice, inspiration and resources for teaching in developing countries, application forms to join an APLS International program, fascinating first-hand experiences from overseas instructors and lots more.
There's also information about the annual PEDs Scholarship. This program brings a local clinician to Australia for a two week hospital attachment followed by an APLS course, GIC course and mentorship to set up an APLS network in their own country. Nominations are always welcome.
If you'd like to discover more about the PEDs Scholarship application process and the superb work our International Committee do in nurturing APLS programmes across Asia and the Pacific, you can visit the international hub here.
Happy 2018 to all our APLS members. With the 20th year celebration well and truly over we have hit the ground running here at APLS with four courses in January and our busy period fast approaching.
We have also locked in the place, dates and times for PAC 2018 during the summer. We are holding this year's conference in Hobart at Wrest Point Hotel and Convention Centre on the 25-27 October 2018. Our PAC Scientific Committee has had a preliminary meeting already to discuss the feedback from PAC 2017 and take into account any issues raised from last year to help create an even better quality PAC Conference in 2018.
2018 is also a significant year for APLS in that the APLS Board has set aside Friday 18 May as a full board strategy day. We have had previous strategy days in 2011 and 2014 so this day is building on the outcomes of those earlier sessions. We are also looking into the future with the aim of producing a five year strategic plan that sets out the broad strategy of the company from 2018-2023.
So, to assure you all, I do not envisage such a strategy not confirming APLS continuing to run PLS and APLS courses around Australia in capital, regional and rural settings. We will continue also to run GIC and international courses.
Without pre-empting the discussion and the direction ultimately reached by the Board and in no particular priority order, we may discuss and consider, for example, the following initiatives:
- Refresher courses for APLS
- Some form of Advanced Paediatric Course
- Courses other than a Refresher or an Advanced Paediatric Course that we should be exploring or considering; and
- Offering a short form online course utilising our existing online learning package
Obviously, we also will be exploring how to make our APLS, PLS and GIC courses even better as part of this day. Once the Board has settled on a strategic plan we understand that it is very important to get input on and inform our terrific instructor/director base of the strategy of the company for 2018-2023. We will update you on this as soon as possible.