Board 152 - Program Innovations Abstract Transcontinental Telesimulation

Introduction/Background The Managing Emergencies in Paediatric Anaesthesia (MEPA) course was conceived in the UK in 2006.1 Initially, a collaboration comprising a few simulation centres with a core faculty of paediatric anesthesiology educators, the spirit of collaboration has been maintained as the group has grown to include MEPA centres delivering a standardized curriculum in multiple centres on four continents. We describe the evolution of the program from a local simulation course to an international network. Methods Post-graduate training in paediatric anesthesiology is of insufficient duration to encounter those operating room emergencies, which would be considered key competencies for any anesthesiologist. In 2005 our group liaised with the Royal College of Anaesthetists (UK) to define which crises would be considered core for inclusion in a one day simulation course designed for year four anaesthesia trainees. Our initial group was a collaboration between several UK paediatric hospital simulation centres. Each case scenario was constructed based on a thorough literature review and then subjected to the scrutiny and refinement of a national committee of paediatric anesthesiologists thus creating a robust course content. The MEPA movement grew to include more centres in the UK. Start-up centres would send their faculty to observe a course at an existing centre before running their first course with the assistance of visiting faculty from the established centre. This "ambassador faculty" model allowed standardization of content, uniformity of delivery and quality assurance. The MEPA collaboration grew such that by 2010 it was available in every post-graduate medical training program in the UK (over twenty deaneries). In 2010 we began dissemination of the course across paediatric hospitals in Canada and also exploring some research questions. Within Ontario we used the ambassador faculty model but the large distances involved in interprovincial collaboration prohibited this and so we used "telesimulation". The existing telemedicine secure videoconferencing infrastructure is used for multiple new centres to observe remotely the course conducted in Toronto. Between scenarios, collaborators can contribute to the debriefing of learners ("tele-debriefing") or observe debriefs, thus there is a faculty development component to the activity. Similarly, new centres’ first courses are observed remotely by established faculty to provide support, feedback and guidance. In this way, the scenarios are conducted identically in all the centres worldwide - important as they are the foundation of some multicentre education research studies. Via presentation and publication2 of early Results, networking at international simulation meetings and word-of-mouth, uptake of the MEPA course has continued. Telesimulation has facilitated expansion into centres in the USA, Australia and Africa. The committee meets at least annually at international paediatric anaesthesia or simulation conferences and maintains connectivity via website www.mepa.org.uk. The research focus of the group has been the validation of simulation-based assessment tools in paediatric anaesthesia to inform the evolution of summative evaluations of trainee competence. The course is also the focus of some multicentre research in debriefing.3 The course content has expanded, with an allied course aimed at practicing anesthesiologists with occasional commitment to paediatric anaesthesia. This MEPA - For Consultants (MEPA-FC) course has been incorporated into the revalidation (maintenance of certification) process in the UK. In the last year, MEPA-FC has been run at a number of MEPA centres in the UK and starts in Australia in September 2013. Results: Conclusion Our group has expanded internationally with sustained momentum, taking advantage of a range of technological solutions to recruit new centres. We have created a paediatric anesthesia simulation network that is, to our knowledge, the largest worldwide. We continue to seek new centres to join the collaboration in the delivery and expansion of the existing curriculum and/or participation in the research projects. References 1. Molyneux M, Lauder G. A national collaborative simulation project: paediatric anaesthetic emergencies. Pediatric anesthesia. 2006;16(12) 2. Everett T, Ng E, Power D, Marsh C, Tolchard S, Shadrina A, et al. The Managing Emergencies in Paediatric Anaesthesia global rating scale is a reliable tool for simulation-based assessment in pediatric anesthesia crisis management. Pediatric Anesthesia. 2013 (advanced online access). 3. Everett T, Bould MD, Cheng A, Eppich WJ, MacKinnon R, editors. Characterizing the debriefer: a mixed Methods, sequential-explanatory study of debriefing in simulation. Society for Pediatric Anesthesia Winter Conference; 2013; Las Vegas, NV. Disclosures None.

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