ILL MEDICAL PATIENTS: ACUTE CARE AND TREATMENT

Magnus Garrioch, FRCA, FRCP

IMPACT National Director, Consultant in Critical Care, Manchester Royal Infirmary Royal College of Physicians of London, College Tutors Day 28th November 2012

IMPACT Project
Describe the project and what it does
Describe the successes of the project Describe the challenges ahead Take a straw pole of what RCPL Tutors think about IMPACT Encourage RCPL tutors to assist/nominate

IMPACT what is it?

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In 2000, courses for cardiac arrest (ALS), trauma (ATLS), surgical critical illness (CCrISP)... Nothing obvious for physicians
IMPACT working party formed in 2003 A 2 day course to improve the recognition and management of the acutely ill medical patient Sponsored by Federation of Medical Royal Colleges, Royal College Anaesthetists and supported by Resuscitation Council and Intensive Care Society Approved by Royal College of Physicians Committee on Core Medical Training for CT1/2 trainees in GIM, Acute Medicine and ACCS

Comparing IMPACT with other courses

ALS

CCrISP ALERT / AIM

ILS

IMPACT what does it do?

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Teaches recognition and treatment of critical illness based on ABC(DE) principles to enable management of the acutely unwell medical patient

ACS, asthma, COPD, Diabetes, Poisoning etc. Skills of central venous cannulation, pleural drainage and NIV

Communication and referral skills

The course provides the following:

Text book (manual) Key point presentations (lectures) Workshops/ hands on skills stations/ critically ill patient scenarios with actors Assessment: continuous and summative from scenario

16 medical candidates on each course with 4 nurse observers

IMPACT Example of a scenario

IMPACT: SUCCESSES

Widespread uptake
Inverness Aberdeen Glasgow Edinburgh Belfast Dumfries Sunderland Middlesborough Isle of Man Harrogate Hull Manchester Wirral Nottingham Kings Lynn Birmingham Ipswich Merthyr Tydfil Bristol Cardiff Barnet London (x3) Guildford Taunton Plymouth

New centres in 2008

Interest from
Northampton Liverpool Wrexham

Norwich
Stevenage Lancaster

Increasing course numbers

60 50

40
Number30 20 10 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 Year

IMPACT instructor days

12 10

8
Number 6 4 2 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 Year

Candidate numbers

Total number of doctor candidates who have done IMPACT since inception - 4635 This year (1st Nov 2011 - 25th Sept 2012)

589 candidates

Post course feedback

Positive Cant recommend it highly enough Extremely useful for clinical practice has rekindled my interest in acute medicine I feel more confident about my knowledge and ability to deal with acute situations Excellent practical sessions and scenarios The small group sessions discussion and practical were excellent and enhanced my knowledge I found the IMPACT book very useful, to the point and easy to read. I would not hesitate to recommend the course to my colleagues

Post course survey feedback

Positive Very informative lectures and hands on scenarios were brilliant Feel more confident when approaching acutely unwell patient Really excellent course faculty friendly and good quality teaching I feel more calm and focussed in acute situations Small group teaching and scenario based learning is an excellent way of teaching as it allows explanation without feeling intimidated by a large group Good consolidation of existing knowledge with reinforcement of a robust system of assessing patient

I wish I had this course during FY2. I believe this course should be mandatory like ALS for at least the people who are going to do medicine or related specialties

Post course survey feedback

Negative I felt a lot of the course content wasnt particularly new and that it was probably pitched at FY2 level Course material too basic for CT1/2 level. I was expecting more advanced content than ALS in terms of ventilatory support, arrhythmia recognition. Course probably more useful for medical students/ foundation doctors This course was not pitched at FY2/ST1 level in its delivery although the content set out by IMPACT would have been very useful for this stage of training I would personally prefer a more formal assessment at the end or at least some faculty feedback on my performance

Post course survey feedback

Negative Need more simulated scenarios, more practice = better performance For a CMT Trainee course too basic Disappointed that some sessions taught by people out of their speciality it showed! The course itself was very good, well conducted and useful. The course manual, however, is full of grammatical, spelling and even medical or content errors. It just needs better editing!

Lectures sometimes covered topic so superficially at such a basic level that they seemed almost pointless (e.g. lecture on AKI pitched at medical student level)

IMPACT future direction

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Keeping this a high quality course

Responding to feedback

Keeping the course up to date

Curriculum development group (15 members) Need to expand CDG Plan to upgrade course over the next year

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Interaction with other teaching (simulators) Acute care scenario in PACES The F2 CT1/2 debate

Should the course be used for F2 teaching?

IMPACT upgrade

Basic subjects stay the same but some additional material

Acute arrhythmia management Fluids and transfusion Acute presentations of chronic kidney disease

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Compulsory on-line reading Face to face teaching

more emphasis on case based discussions

IMPACT challenges ahead

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Keeping the course up to date

Curriculum development group (15 members) Need to expand CDG Plan to upgrade course over the next year

The F2

CT1/2 debate

Should the course be used for F2 teaching?

When upgraded should we work towards compulsory for acute specialties?

IMPACT Feedback - What do you think?

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The project?
Should it be a Royal College thing? The F2 CT1/2 debate? Compulsory for acute specialties? Suggestions

Questions?

IMPACT Project

Describe the project and what it does

Describe the successes of the project Describe the challenges ahead Take a straw pole of what RCPL Tutors think about IMPACT Engage more closely with RCPL Do you want to get involved?