The Use of Distance Learning Technologies to Bring Simulation-based Critical Care Training to a Remote Community in Northern Canada

Timothy Willett MD, CRI Critical Care Education Network,Royal College of Physicians and Surgeons of Canada
Susan Brien, MD MEd CSPQ FRCSC CPE, Royal College of Physicians and Surgeons of Canada
Pierre Cardinal, MD MScEpi FRCPC, CRI Critical Care Education Network
Rick Hodder, MD MSc FRCPC, University of Ottawa
John Kim, MD MEd FRCPC, University of Ottawa
David Neilipovitz, MD FRCPC, University of Ottawa
Shahin Shirzad, MD, University of British Columbia

In remote northern communities, family physicians must recognize and stabilize critically ill patients while awaiting transport. Access to state-of-the-art education, including simulation, is a barrier that presents a further challenge to practitioners. The 16-hour ACES (Acute Critical Events Simulation) course was adapted to meet the priority needs and reflect the clinical context in Iqaluit, Nunavut, Canada. The course was delivered by using e-learning modules then TeleMedicine sessions for didactics, case-based discussions, task training and simulation by virtual patient. The course was evaluated using: post-course questionnaires; pre- and post-course quizzes; post-course high fidelity simulations (measured by behavioural checklist and global rating scale on crisis resource management); and delayed post-course interviews. Participants indicated the course was highly relevant, increased their confidence to manage critical cases, and increased their perceived competence. There was a 28% improvement in scores on the quiz. The vast majority of participants exceeded the expected level of performance on the high fidelity simulations. In the follow-up interviews, participants were able to cite specific practice changes they had made and noticed in others. This model of distance learning reduces the barriers of distance and associated costs while maintaining interactive advanced learning modalities, and is effective at helping to prepare remote clinicians for medical crises.