Evaluating multisite multiprofessional simulation training for a hyperacute stroke service using the Behaviour Change Wheel.
BACKGROUND
Stroke is a clinical priority requiring early specialist assessment and treatment. A London (UK) stroke strategy was introduced in 2010, with Hyper Acute Stroke Units (HASUs) providing specialist and high dependency care. To support increased numbers of specialist staff, innovative multisite multiprofessional simulation training under a standard protocol-based curriculum took place across London. This paper reports on an independent evaluation of the HASU training programme. The main aim was to evaluate mechanisms for behaviour change within the training design and delivery, and impact upon learners including potential transferability to the clinical environment.


METHODS
The evaluation utilised the Behaviour Change Wheel framework. Procedures included: mapping training via the framework; examination of course material; direct and video-recorded observations of courses; pre-post course survey sheet; and follow up in-depth interviews with candidates and faculty.


RESULTS
Patient management skills and trainee confidence were reportedly increased post-course (post-course median 6 [IQ range 5-6.33]; pre-course median 5 [IQ range 4.67-5.83]; z = 6.42, P < .001). Thematic analysis showed that facilitated 'debrief' was the key agent in supporting both clinical and non-clinical skills. Follow up interviews in practice showed some sustained effects such as enthusiasm for role, and a focus on situational awareness, prioritization and verbalising thoughts. Challenges in standardising a multi-centre course included provision for local context/identity.


CONCLUSIONS
Pan-London simulation training under the London Stroke Model had positive outcomes in terms of self-reported skills and motivation. These effects persisted to an extent in practice, where staff could recount applications of learning. The evaluation demonstrated that a multiple centre simulation programme congruent with clinical practice can provide valuable standard training opportunities that support patient care.
Glasgow Dental School, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK. alastair.ross@glasgow.ac.uk.
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Ross
Simulation and Interactive Learning (SaIL) Centre, St Thomas' Hospital, King's Health Partners, London, UK. gabriel.reedy@kcl.ac.uk.
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Reedy
Friends Stroke Unit, Kings College Hospital, Kings Health Partners, London, UK. angela.roots@nhs.net.
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Simulation and Interactive Learning (SaIL) Centre, St Thomas' Hospital, King's Health Partners, London, UK. peter.jaye@gstt.nhs.uk.
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Department of Ageing & Health, St Thomas' Hospital, King's Health Partners, London, UK. jonathan.birns@gstt.nhs.uk.
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Birns
D000208:Acute Disease; D002983:Clinical Competence; D003479:Curriculum; D006801:Humans; D008131:London; D010348:Patient Care Team; D015397:Program Evaluation; D011787:Quality of Health Care; D000066908:Simulation Training / Q000379:methods* / Q000458:organization & administration; D020521:Stroke / Q000628:therapy*